Is Being on Medicaid Worse Than Having No Insurance at All?

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Probably not. But for cancer patients in Ohio, where those that rely on Medicaid survive for less time than others, it's easy to think so.

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Cancer patients on Medicaid survive less time after their diagnosis than people with private or no insurance, data from Ohio show. Looking only at highly treatable types of tumors, researchers found Medicaid enrollees were between 1.6 and 2.4 times as likely as other patients to die of their disease within five years. It's unclear exactly how to interpret those findings, but researchers agree they're important.

"This shows that there are problems at a national level that we need to be aware of," said Dr. Derek Raghavan, who worked on the study. "While Medicaid is potentially lifesaving, it is better to be able to support yourself and have insurance that protects at a higher level than just Medicaid," added Raghavan, who heads the Levine Cancer Institute in Charlotte, North Carolina.

Raghavan and colleagues looked at eight different cancers, such as testicular cancer and early-stage colon and lung cancer, in patients from an Ohio cancer registry. With treatment, patients typically survive more than five years with those diseases, so doctors often refer to them as "curable."

"While Medicaid is potentially lifesaving, it is better to be able to support yourself and have insurance that protects at a higher level."

The new study, published in the journal Cancer, tracked more than 11,000 patients with private or no insurance and 1,345 Medicaid beneficiaries, half of whom enrolled after or around the time they got their diagnosis. All were between 15 and 54 years old.

Of the non-Medicaid patients, fewer than one in 10 died within five years of their cancer diagnosis. By comparison, more than one in five Medicaid patients died during that period, and those who enrolled in Medicaid later survived the shortest time.

The latter result is crucial, said Dr. Karin Rhodes, who directs the Division of Health Policy Research at the University of Pennsylvania School of Medicine in Philadelphia and was not part of the new research. "It is actually the impact of being uninsured," she told Reuters Health. "This really highlights the importance of fully implementing the Affordable Care Act and getting everybody fully insured."

However, she said, many factors might be involved in explaining the survival gap. Although the researchers tried to rule out some of those -- age, Zip code, and cancer stage, among others -- it's impossible to account for all the factors that might be at play.

Still, to Rhodes, it's a question of access to good primary care. "I doubt that there are huge disparities in the type of treatment they got," she said. "I think it is when they got it."

Earlier this year, she published a study showing that sick kids covered by Medicaid or the Children's Health Insurance Program (CHIP) must wait twice as long as those with private insurance to see a specialist. "Physicians' willingness to give a timely appointment or to give an appointment to someone is directly proportional to how much reimbursement they get," Rhodes said.

What ends up happening is that many patients get treatment too late, she added. "You are putting a lot of resources at the end of life -- that is where most of our expenses are, as opposed to doing prevention," Rhodes said, adding that the increased reimbursement rates promised with health reform might shift the balance to better preventive care and earlier treatment.

Raghavan was less convinced that differences in early care and prevention can explain his findings. "What we think is, people who have been on Medicaid for a while understand the system," he told Reuters Health. When they get sick, "it is not such a shock for them" and they have an easier time getting treatment.

He said it's unlikely that the longer survival among non-Medicaid patients reflects more cancer screening, which might spot tumors earlier and that way artificially inflate a cancer patient's lifespan -- a phenomenon called lead-time bias. "For lead-time bias to be relevant here, we would need to consider all stages of disease," not just the early stages, Raghavan said. He added that more research is needed to find out whether Medicaid patients get worse treatment than others.

To Raghavan, universal health care is unlikely to get rid of all disparities, but he cautiously agreed with Rhodes that it might be helpful to some degree. "Providing better insurance potentially will increase survival with one very important caveat, and that is, we need to be sure that our politicians have the mechanism to pay for their plan," he said. Meanwhile, targeting health care access among minorities could go a long way toward solving the problem, he said.

Image: Dewayne Flowers/Shutterstock.

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Frederik Joelving is a reporter for Reuters.

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