While the majority of the visitors to this website appreciate the crucial role of medical insurance in obtaining breast cancer screening, diagnosis and care, this view is not shared universally. For example, some commentators have asserted that the uninsured can always find treatment in hospital emergency rooms. However, emergency rooms are not able to treat breast cancer. Chemotherapy, for example, is not available in any emergency room. Now a new study has reported that a 2005 Medicaid rollback in Tennessee resulted in later stage breast cancer diagnoses among low-income women.

Lack of insurance worsens outcomes

Cancelling Medicaid or other insurance affordable only with the subsidies provided through the Affordable Care Act (Obamacare) is likely to result in increased breast cancer-specific deaths. Studies that have examined the associations between insurance status and breast cancer screening and care have reported the following:

  • The uninsured are far less likely to undergo routine mammograms or other breast cancer screening than the insured. Since such screening is associated with detection of breast cancer at early stages, a lack of insurance can lead to a later stage of breast cancer diagnosis, with the associated increase in mortality.
  • High-risk uninsured women with a close family history of breast cancer are less likely to obtain BRCA1 and BRCA2 testing, thereby forgoing any ability to take proactive steps to prevent likely breast cancer.
  • The uninsured are less likely to receive standard care for breast cancer. For example, the uninsured have lower rates of breast conserving treatment, including radiotherapy, than the insured. Instead, they tend to undergo mastectomy without reconstruction.
  • Uninsured status has been found to be associated with early death among women with stage IV breast cancer at diagnosis.
  • Uninsured breast cancer survivors have difficulty accessing follow-up care and breast cancer surveillance after treatment. Cancer survivors in non-Medicaid expansion states had significantly lower likelihood of having a personal physician and higher likelihood of being unable to see a doctor because of cost in one study.
In short, a typical pattern for an uninsured women is a delay in obtaining a mammogram until the tumor is palpable, followed by treatment delays as the woman struggles to access whatever resources may be available for to pay for treatment, followed in turn by potentially substandard treatment and a lack of adequate follow-up care. Each of these suboptimal steps in detection through survivorship have the potential to result in increased breast cancer-specific mortality.

Latest research finds Medicaid disenrollment increases stage at diagnosis

The study referenced at the beginning of this news story was designed to investigate the effects of the 2005 Medicaid disenrollment in Tennessee on stage at diagnosis and delays in treatment among nonelderly women. States such as Tennessee have a history of rolling back Medicaid eligibility to deal with unfavorable statewide economic conditions. To conduct the study, the authors used 2002-2008 data from the Tennessee Cancer Registry. They compared women diagnosed with breast cancer who lived in low-income zip codes (and more likely to be disenrolled) with otherwise similar women who lived in high-income zip codes before and after the 2005 Medicaid disenrollment.

Overall, nonelderly women in Tennessee were found to be diagnosed with breast cancer at later stages and to experience more treatment delays after disenrollment. Disenrollment was associated with a 3.3% increase in late stage disease at diagnosis for women living in low-income zip codes compared with women living in affluent zip codes. However, the authors did not find significant increases in delays in obtaining surgery when comparing women in low-income zip codes to those in affluent zip codes. The authors conclude that Medicaid disenrollment is associated with a later stage of disease at the time of diagnosis, which is evidence of potential negative health impacts of Medicaid rollbacks.