The Exchange

Commentary and Observations from
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Breaking Down Racial Disparities in Cancer Care: The Affordable Care Act

Breaking Down Racial Disparities in Cancer Care: The Affordable Care Act

Racial disparities are well known to exist in cancer care and outcomes. Several barriers exist including access to care, cultural biases about healthcare and providers, and cost of medical care. At the American Society of Clinical Oncology meeting in early June 2019, a plenary session was dedicated to the presentation of research looking at the impact of Medicaid expansion as part of the Affordable Care Act (ACA) and its relationship to cancer care and outcomes across different racial groups.

The ACA expanded Medicaid and provided subsidies for purchasing private health insurance in several states. The aim was to improve equity in access to healthcare as well as outcomes. Using the Flatiron Health electronic medical database, researchers gathered data between January 1, 2011 and December 31, 2018 on patients with several different solid tumor types: lung cancer, breast cancer, and colon cancer, as well as several others. The main outcome for measurement was “timely treatment,” which was defined as starting first-line treatment for their cancer within 30 days of the original diagnosis.

The study included over 34,000 patients with a median age of 57, 12% of which were African Americans. In the pre-ACA dates, African Americans were 4.9% less likely than whites to receive timely treatment. Once the ACA was implemented, regardless of race, there was a trend toward improvement in time to treatment. In the time period post-ACA, there was a 6.9% increase in timely treatments for African American patients with cancer, and 1.8% for white patients with cancer.

In conclusion, the ACA—including Medicaid expansion and subsidies for private insurance—improved access to care and reduced racial disparities in cancer care.

  • Adamson BJS, Cohen AB, Estevez M, et al. Affordable Care Act (ACA) Medicaid expansion impact on racial disparities in time to cancer treatment. J Clin Oncol. 2019;37:18(suppl). Abstract LBA1.

Filed under: Oncology/Hematology

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