Under Obamacare, the Medicaid expansion in New York has radically increased racial disparities in the availability of cancer treatments, at the expense of African Americans. It seems the signature legislative accomplishment of America’s first black President is not exactly helping those he claimed to represent.
The journal of the American College of Surgeons explains that, “The Affordable Care Act’s (ACA) Medicaid expansion has been heavily debated due to skepticism of Medicaid’s ability to provide high-quality care. Particularly, little is known whether Medicaid expansion improves access to surgical cancer care at high-quality hospitals. To address this question, we examined the effects of the 2001 New York Medicaid expansion, the largest in pre-ACA era, on this disparity measure.”
The researchers evaluated a total of 67,685 patients that ranged from age 19 to 64 years, and had one of the 9 types of procedures for the cancer treatments including cancers of lung, bladder, rectum, colon, kidney, liver, pancreas, stomach, and esophagus. These types of cancer were evaluated because of the higher mortality and morbidity risks involved.
Researchers explained that they wanted to assess the racial disparity as the African American patients are mostly uninsured and could possibly benefit to the most from the expansion of the Medicaid program. Furthermore, the proportion of the minority patients covered didn’t exactly increased under the New York’s Medicaid expansion in the year 2001.
As per the doctor’s evaluation, 15% of the patients were either uninsured or were covered by Medicaid. 12% were African American and other 67percent were whites.
The study says, “Disparity in access to high-volume hospitals for surgical cancer care between African-American patients and non-Hispanic white patients was decreasing by 0.43%age points per quarter in the pre-expansion period. Over the 21-month post-expansion observation, the increase accumulates to 18.3%age points. Racial disparity in access to low-mortality hospital shows a similar pattern, decreased briefly at the time of the expansion by 5.6%age points, but increasing following expansion by 0.48%age points per quarter.”
“It has been widely reported that Medicaid coverage expansion has improved access to a variety of health care services, including primary care, subspecialty surgical care, and surgical cancer care. However, increased coverage and care utilization has not been shown to be strongly associated with better health outcomes,” the study explained.
“There has also been literature suggesting expanded Medicaid coverage generated no significant improvements in physical health outcomes despite the increase in utilization of health care services,” the authors said.
Waddah Al-Refaie, the study’s leader noted that, “New York’s Medicaid expansion, one of the largest in U.S. history before the Affordable Care Act, improved access to cancer surgery for the previously uninsured. However, it did not appear to preferentially benefit ethnic and racial minorities who are typically the most vulnerable of America’s poorest population.”
“There was a sharp decrease in the uninsured, but the proportion of the racial minority patients undergoing cancer surgery through Medicaid—about 25% African American and 13% Hispanic—did not change,” said Al-Refaie.