After Kentucky opted to expand Medicaid coverage in 2014, its uninsured rate fell from 19% to 7%. Researchers evaluated the impact of Medicaid expansion on the quality of breast cancer care among state residents.

Data were obtained from the state cancer registry for all women 20 to 64 years of age who were diagnosed with breast cancer between 2011 and 2016. During the study period, 13,625 women were treated for breast cancer: almost half received treatment between 2011 and 2013, before Medicaid expansion, whereas a little more than 50% were treated between 2014 and 2016, after Medicaid expansion. The annual incidence of breast cancer was similar in the two periods.

The researchers found that fewer patients were uninsured (1% versus 3.7%) and more were covered by Medicaid (15.9% versus 10.9%) after the expansion of Medicaid than before. They noted an increased number of early-stage breast cancer diagnoses and found that more women underwent breast conservation surgery (48.8% versus 44%) after expansion than previously. The proportion of women receiving radiation after breast-conserving therapy remained the same (at about 85%). After Medicaid expansion, the time from diagnosis to surgery among patients not receiving preoperative chemotherapy increased (from 28.6 to 36 days), but the time from surgery to radiation decreased (from 96.4 to 91.5 days); the time from surgery to chemotherapy remained relatively unchanged (about 47 days).

The authors say their observations point to an improvement in the diagnosis and appropriateness of treatment in women with breast cancer after the expansion of Medicaid. These changes may reflect improved access to care. However, the authors note that improving the expediency of breast cancer treatment is likely to require better patient outreach and education, cancer care coordination, and health care infrastructure.

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