The Washington PostDemocracy Dies in Darkness

ACA linked to reduced racial disparities, earlier diagnosis and treatment in cancer care

New research backs up earlier data showing the law increased access to care.

The website, used for signing up for insurance under the Affordable Care Act. (Alex Brandon/AP)

Proponents of the embattled Affordable Care Act got additional ammunition Sunday: New research links the law to a reduction in racial disparities in the care of cancer patients and to earlier diagnoses and treatment of ovarian cancer, one of the most dangerous malignancies.

The findings, coming as health care emerges as an increasingly important issue in the 2020 presidential campaign, were released Sunday as abstracts at the annual meeting in Chicago of the American Society of Clinical Oncology. The conference attracts some 40,000 cancer specialists to one of the world’s largest oncology meetings.

According to researchers involved in the racial-disparity study, before the ACA went into effect, African Americans with advanced cancer were 4.8 percentage points less likely to start treatment for their disease within 30 days of being given a diagnosis. But today, black adults in states that expanded Medicaid under the law have almost entirely caught up with white patients in getting timely treatment, researchers said.

Another study showed that after implementation of the law, ovarian cancer was diagnosed at earlier stages and that more women began treatment within a month. The speedier diagnoses and treatment were likely to have increased patients’ chances of survival, the researchers said.

Health policy experts who were not involved in the studies said the findings are consistent with previous data showing that the ACA is associated with improved access to health insurance and medical care.

“What’s new here are findings that the ACA and Medicaid expansions have had specific impacts on patients with cancer, and that’s great,” said Justin Bekelman, a radiation oncologist and health policy professor at the University of Pennsylvania.

But, Bekelman said, the studies did not address whether the ACA lengthened survival or improved quality of life — the two things that matter most to patients. “It’s logical” that the law has had those effects, but “we need the evidence,” he said.

Other experts noted that the racial-disparities study, while good news, highlighted the emergence of a different kind of inequality. “There’s increasing concern about greater disparities” between states that chose to expand Medicaid and those that did not, said Robin Yabroff, an epidemiologist at the American Cancer Society. The Supreme Court made expansion of that program optional when it upheld the ACA’s constitutionality in 2012.

Otis Brawley, a Johns Hopkins oncologist and former chief medical and scientific officer at the cancer society, agreed. “We are moving from black-white disparities to Massachusetts versus Mississippi disparities,” he said.

The new research was released amid intensifying legal and political battles over the health law. The Trump administration joined Republican-led states last month in asking a federal appeals court to strike down the entire law as unconstitutional — a decision that could end health insurance for millions of Americans. Democrats have largely defended the law and pushed plans to shore it up and expand it, but some want to move more quickly toward a single-payer system.

The study on racial disparities involved an analysis of electronic health records led by researchers at Yale Cancer Center and Flatiron Health, a health data company with a large database of records that have been stripped of individual identifying information. The researchers studied more than 30,000 electronic health records between 2011 and 2019 in the Flatiron database.

The study found that the percentage of black patients beginning treatment within a month of receiving diagnoses of any of eight advanced cancers rose from 43.5 percent to 49.6 percent in Medicaid-expansion states, compared with a smaller improvement of 48.3 percent to 50.3 percent for whites.

The disappearance of the gap involving timely treatment suggests that state Medicaid expansions “led to improved health equity,” said Amy Davidoff, a senior research scientist at Yale.

Traditionally, she said, African American cancer patients have been less likely than whites to have insurance. That, in turn, has meant it takes them longer to find health providers, get financial help for their medical needs and initiate treatment — with poorer survival outcomes.

Anna Jo Smith, a Johns Hopkins gynecologist who was lead author on the ovarian cancer study, emphasized the importance of early detection and treatment of the disease. More than 75 percent of women diagnosed with early-stage ovarian cancer live at least five years, but that number falls to less than 30 percent for those diagnosed with advanced disease. Having health insurance is critical to having doctors who can monitor symptoms and act on them if necessary, Smith said.

Another study released Sunday identified socioeconomic factors that are associated with multiple myeloma, a serious blood cancer. That study, led by researchers at University Hospitals Seidman Cancer Center in Cleveland, noted better outcomes for patients who had private insurance, lived in higher-income areas and received treatment at academic medical centers.

Read more:

Two dozen states, municipalities, sue over Trump’s ‘conscience’ rule

White House runs into health-industry hostility as it plans executive order

Medicare proposes higher reimbursement for innovative cancer treatment