| Credit: Photo by National Cancer Institute on Unsplash

People died of cancer at higher rates in the years following the passage of the Affordable Care Act in states like South Carolina, where political leaders chose not to expand Medicaid under the new law, according to a study published in the Journal of the National Cancer Institute.

The study is the first of its kind to look at the impact of Medicaid expansion on cancer mortality rates, according to Dr. Evan Graboyes of the Medical University of South Carolina’s Hollings Cancer Center, one of the report’s authors.

“Through this study, we estimate that over 5,000 cancer deaths were prevented during the study period in early Medicaid expansion states,” Graboyes told MUSC’s Catalyst in a report published last week.

The study compared non-senior adults who died of cancer before and after adoption of the landmark 2010 health care law, showing improved mortality rates in states that expanded Medicaid eligibility. South Carolina is currently one of 12 states that has not expanded Medicaid under the Affordable Care Act.

Medicaid covers health expenses for people who are children, elderly, disabled, pregnant or parents of minors. But because the ACA was designed with Medicaid expansion in mind, many childless, low-income adults are not eligible and also do not qualify for financial assistance for insurance on the federal marketplace. If South Carolina were to expand Medicaid, an additional 188,000 uninsured people would be eligible for coverage, according to the according to the Kaiser Family Foundation. The state would be on the hook for a portion of expansion expenses, but the federal government covers about 90% of costs, according to the foundation.

The study examined county-level data from the National Center for Health Statistics for adults ages 20-64 for the period before expansion (2007-2009) and after (2012-2016).

By looking at the change in rates over time, researchers were able to see that despite advancements in cancer care in states regardless of Medicaid expansion, there was still a correlation between expansion and mortality, according to Catalyst.

Cancer patient mortality showed improvements across the board, but expansion states, with 64.8 cancer deaths per 100,000 people, had a lower death rate than nonexpansion states, with 79.4 cancer deaths per 100,000 people.

Researchers noted a marked difference in changes between expansion and nonexpansion states with regards to pancreatic cancer, which generally has a poor prognosis. Over the course of the study, 2007-2016, expansion states saw pancreatic cancer mortality rates decrease from 4.47 deaths per 100,000 people to 4.22 deaths. In states that didn’t expand Medicaid, pancreatic mortality rates increased from 4.72 deaths per 100,000 to 4.87 deaths.

“This is the first study to show that Medicaid expansion decreases the risk of dying from cancer,” Graboyes said.

The findings in the latest MUSC study correspond with a separate May report by Dr. Gerard Silvestri that found insurance status affects health outcomes for cancer patients more than age.

“The results of this study led me to ask this simple question: ‘Is it OK for a patient to die from cancer simply because he or she does not have health insurance?’ If the answer is ‘no’ to that question, then a true policy discussion needs to happen at a high level,” Silvestri told Catalyst.

But Duke University’s Nosayaba Osazuwa-Peters, one of the authors of the expansion study, noted expansion is not necessarily a cure-all.

“We hope that when people examine Medicaid expansion or the Affordable Care Act that they see that its implications could be more than just preference or choice,” he said. “It could be a matter of life and death for some cancer survivors.”

Federal budget and reform measures being debated now could expand coverage for uninsured in nonexpansion states without approval of the states’ leaders, but those proposals still need full congressional approval.