Joseph Benitez is a health services researcher, health economist and assistant professor in the Department of Health Management and Policy at the University of Kentucky, as well as a member of the 2021 Tradeoffs Research Council. His research interests include the impacts of public policy changes on the medically underserved, Medicaid policy and the role of Medicaid as a safety-net program.

Prior to the passage of the Affordable Care Act (ACA), delaying needed medical care until the onset of Medicare eligibility was not uncommon. In particular, researchers have long noted that cancer diagnoses skyrocket when people turn 65, due to people gaining new or improved health coverage through Medicare, and that these diagnoses were often of later-stage cancers that could’ve been treated more effectively if caught earlier.

This is the set-up for an interesting paper by Fabian Duarte, Srikanth Kadiyala, Gerald F. Kominski and Antonio Riveros in the February 2021 issue of Health Affairs exploring whether the ACA’s major coverage provisions helped address this problem in cancer detection. The authors used the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program database to study whether the ACA’s coverage expansions (i.e. Medicaid expansion and federal subsidies for individual coverage) and expanded benefits (i.e. covering cancer screenings with no out-of-pocket costs) caused the gap in newly detected cancers between near-eligible (age 60-65) and Medicare-eligible (65-70) people to shrink.

They found that the ACA reduced the increase in cancer detection at age 65 by 45%, with the bulk of newly detected cancers being in their earlier stages when they can be treated less invasively and more effectively. While this study did not measure mortality impacts, when combined with other studies of the ACA’s impacts on preventable mortality, it strengthens the case that the ACA’s coverage gains have saved lives.

The SEER database only includes cancer diagnoses for 37% of the country, so further study is needed to confirm if the effect holds for a larger population. And the researchers didn’t estimate how much of the increased cancer detection was due to Medicaid expansion versus expanded coverage on the individual market (although previous research has shown that Medicaid expansion increased many kinds of cancer screenings). 

But with Congress set to increase ACA subsidies and offer new incentives for the remaining 12 states to expand Medicaid — and with the fate of the entire Affordable Care Act hanging in the balance at the Supreme Court — this study makes a persuasive case for the preventive power of health coverage.