Abstract A121: Effect of state Medicaid expansion status on insurance coverage and stage at diagnosis in head and neck cancer patients
Authors: Osazuwa-Peters Nosayaba , Barnes Justin M , Boakye Eric Adjei , Gaubatz Matthew E , Johnston Kenton J , Panth Neelima , Sethi Rosh KV , Megwalu Uchechukwu , Varvares Mark A 
Published: September 2020

Abstract
Objective: Access to care is an important issue for head and neck cancer (HNC) patients as HNC is one of the most expensive cancers, particularly for late stage disease. While some data show increased insurance coverage with Medicaid expansion, evidence is limited for impacts on socioeconomic disparities in insurance or on stage at diagnoses. This study aimed to quantify the impact of state Medicaid expansion status on insurance status and stage at diagnosis in HNC patients. Methods: Using a quasi-experimental design, the 2011-2015 Surveillance, Epidemiology, and End Results database was queried for adults with HNC in the United States. Changes in insurance coverage and stage at diagnosis after 2014 in states that expanded Medicaid (EXP) were compared to changes in states that did not expand Medicaid (NEXP). Difference-in-differences analyses were used to assess changes in the percentage of Medicaid coverage, uninsured, and early stage diagnoses in EXP relative to NEXP states. Results: A total of 26,330 HNC cases were identified. In difference-in-difference analyses, we observed an increase in Medicaid insurance in expansion relative to non-expansion states (3.36 percentage points (PP), 95% CI = 1.32, 5.41, p=.001), especially for residents of low income and education counties. We also observed a reduction in uninsured status among HNC patients in low income counties (-4.17 PP, 95% CI = -6.84, -1.51; p=.002). Additionally, we found significant increases among young adults age 18-34 years (17.2 PP, 95% CI – 1.34, 33.10, p=0.034), females (7.54 PP, 95% CI = 2.00, 13.10, p=0.008), unmarried patients (3.83 PP, 95% CI = 0.30, 7.35, p=0.033), and patients with cancer of the lip (13.5 PP, 95% CI = 2.67, 24.30, p=0.015). There was some evidence for greater expansion-associated increases in early stage diagnoses for non-Hispanic blacks (8.53 PP) and other races (20.4 PP) relative to white HNC patients (p=.025). Conclusions: Medicaid expansion is associated with improved insurance coverage for HNC patients, particularly those with low income, and increased early stage diagnoses for young adults and for racial/ethnic minorities. Thus, Medicaid expansion may improve access to care for patients with HNC. Our findings are particularly relevant at a time when there is debate in the United States about healthcare financing, Medicaid, and the Affordable Care Act.
Citation Format: Nosayaba Osazuwa-Peters, Justin M Barnes, Eric Adjei Boakye, Matthew E Gaubatz, Kenton J Johnston, Neelima Panth, Rosh KV Sethi, Uchechukwu Megwalu, Mark A Varvares. Effect of state Medicaid expansion status on insurance coverage and stage at diagnosis in head and neck cancer patients [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A121.