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Fewer people might die of cancer in Missouri now that the state has expanded Medicaid

 Filing an application for presumptive eligibility is the starting point in applying for Medicaid coverage.
Sebastián Martínez Valdivia
Filing an application for presumptive eligibility is the starting point in applying for Medicaid coverage.

Dr. Miranda Lam of the Dana Farber Cancer Institute was the lead author on a study showing that patients with breast cancer, lung cancer or colorectal cancer had better chances of survival if they lived in a state with Medicaid expansion.

In the first month since Missouri started processing Medicaid expansion applications, some 13,000 people have enrolled in the service. That has major implications for Missourians dealing with cancer, which requires expensive treatment and benefits from early detection.

In fact, one recent study found cancer patients in expansion states had a lower risk of death. Dr. Miranda Lam is a radiation oncologist with the Dana Farber Cancer Institute and was the lead author on the study. She joined the Health and Wealth desk to talk about her findings.

This transcript has been edited for clarity.

Lam: The thought was, if Medicaid expansion could have a positive impact, it may be in cancers where we can actually potentially detect it. And in order for people to be detected with cancer, they have to have access to screening. And often in order to have access to screening, patients need health insurance. We know that patients need more than just health insurance, but that is one important factor for a lot of patients when they seek health care.

In our study, what we found was that for patients with breast cancer, lung cancer and colorectal cancer, that their mortality was improved if they lived in a state with Medicaid expansion, compared to patients with lung colorectal and breast cancer, who lived in a state that did not have Medicaid expansion.

We also tried to delve into understanding potentially why this was occurring. And it seemed based on our data that this mortality benefit was due to earlier stage at diagnosis.

KBIA: And early diagnosis can be tied to a better prognosis overall, right?

Lam: Exactly. So the thought is that patients who are diagnosed at an earlier stage will do better. We know that patients with stage one cancer typically will do better than stage two, three or four. That's often how the staging criteria has come up with. We always want to try to catch people earlier in their stage of diagnosis, if they are to have cancer.

KBIA: So without Medicaid expansion you have patients who might be uninsured or underinsured, like with Medicare Part A, for example, which only covers hospitalization. How does that impact their treatment?

Lam: Patients that only have Part A insurance, and as you say are under insured, may not show up for screening or to doctor's visits, because they don't have coverage for outpatient services.

Unless patients have resources to see their doctor and pay out of pocket for visits in the office, this potentially may lead to delays in diagnosis and delays in care. Our concern always is that patients that show up in the emergency room or in the hospital, usually, it's because symptoms have gotten to a point where it's uncomfortable enough or painful enough.

And so, I think physicians are always concerned when people don't have access to office visits or outpatient care, that, potentially that can lead to later stage at diagnosis. I see cancer patients in clinic and trying to understand what factors, at a national and a state level, that can impact their care is sort of my area of interest, and also a clinical interest because I know that these policies have downstream implications, whether intended or unintended for our patients.
Copyright 2021 KBIA. To see more, visit KBIA.

Sebastián Martínez Valdivia is a health reporter and documentary filmmaker who focuses on access to care in rural and immigrant communities. A native Spanish speaker and lifelong Missouri resident, Sebastián is interested in the often overlooked and under-covered world of immigrant life in the rural midwest. He has a bachelor's degree in broadcast journalism from the University of Missouri and a master's degree in documentary journalism at the same institution. Aside from public health, his other interests include conservation, climate change and ecology.
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