ACS CAN submitted comments to the Centers for Medicare & Medicaid Services regarding its 2022 Request for Information on Access to Coverage and Care in Medicaid & CHIP. Our comments address suggested improvements in Medicaid enrollment and eligibility determination, transitions of coverage, national standards for access to care, and the eventual end of the public health emergency and continuous coverage provisions.
Close the Medicaid Coverage Gap for Cancer Patients and Survivors
Since passage of the Affordable Care Act, 38 states and the District of Columbia have expanded eligibility for Medicaid to all individuals earning up to 138% of the Federal Poverty Level (FPL). But 12 states still have not expanded their programs. As a result, an estimated 2.2 million low-income adults who would benefit from Medicaid if their state expanded coverage are now in the “coverage gap,” uninsured and unable to qualify for affordable health insurance.[i]
Cancer & the Coverage Gap
Individuals who are uninsured – like those in the coverage gap – are less likely to get screened for cancer and are more likely to have cancer diagnosed at an advanced stage when survival is less likely and the cost of care more expensive.[ii] Research shows that Medicaid expansion helps improve cancer outcomes and reduces the burden of cancer by offering access to prevention services, timely cancer screening and early detection services.[iii],[iv],[v]
American Cancer Society research estimates that in 2021, over half a million new cancer cases will be diagnosed in the 12 states that have not expanded Medicaid.[vi] Some of these new cancer patients will fall in the coverage gap and potentially face their cancer diagnosis with no insurance. Research shows that cancer outcomes are better in states that have expanded Medicaid – one recent study showed that Medicaid expansion was associated with better long-term survival across a variety of cancers and for patients with both early- and late-stage disease at diagnosis.[vii]
Health Equity & the Coverage Gap
A 2019 analysis[viii] of individuals in the coverage gap showed:
- 60% of people in the gap were people of color, reflecting long-standing racial and ethnic disparities in health care access – disparities that are also seen in cancer screening, treatment, and survival.
- Most were in the labor force, roughly half were employed, and 1 in 3 were parents with children at home.
- Over half a million workers in the coverage gap were employed in front-line or essential industries, and about 15 percent of adults had a disability.
Addressing the coverage gap is a crucial way to address health inequities in general, and cancer disparities specifically.
Congress & the Administration Must Close the Coverage Gap
ACS CAN strongly urges Congress and the Administration to permanently close the Medicaid coverage gap. Lower income individuals – including those with cancer - should have access to high-quality coverage, adequate benefits, and protections from out-of-pocket costs which may deter them from utilizing their coverage. It is critical that this solution be permanent to ensure patients’ access to quality and affordable coverage is not put in jeopardy in the future.
Congress: Extend quality, affordable coverage to people who need it. Close the coverage gap.
[i] “The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid.” The Henry J. Kaiser Family Foundation, 21 Jan. 2021, https://www.kff.org/medicaid/issue-brief/the-coverage-gap-uninsured-poor...
[ii] E Ward et al, “Association of Insurance with Cancer Care Utilization and Outcomes, CA: A Cancer Journal for Clinicians 58:1 (Jan./Feb. 2008), http://www.cancer.org/cancer/news/report-links-health-insurance-status-with-cancer-care.
[iii] Aparna Soni, Kosali Simon, John Cawley, Lindsay Sabik, “Effect of Medicaid Expansions of 2014 on Overall and Early-Stage Cancer Diagnoses”, American Journal of Public Health 108, no. 2 (February 1, 2018): pp. 216-218.
[iv] Dehkordy, SF, Hall, K, West, B, et al. “Medicaid Expansion Improves Breast Cancer Screening for Low Income Women.” November 30, 2015. https://www2.rsna.org/timssnet/Media/pressreleases/14_pr_target.cfm?id=1849
[v] Ungar, Laura. “More KY Medicaid Patients Get Preventative Care.” Courier Journal. August 7, 2015. Web www.courier-journal.com/story/ life/wellness/2015/08/05/preventive-care-rises-among-kentucky-medicaid-patients/31190973
[vi] 590,200 new cancer cases in the 12 states that have not expanded Medicaid. Number calculated from American Cancer Society. Cancer Facts & Figures 2021. Atlanta, GA: American Cancer Society; 2021.
[vii] Zhao J, Han X, Nogueira L, Jemal A, Yabroff KR. Association of state Medicaid income eligibility limits and long-term survival after cancer diagnosis in the United States. Accessed October 13, 2021. https://meetinglibrary.asco.org/record/196693/abstract
[viii] Center on Budget and Policy Priorities. Closing Medicaid Coverage Gap Would Help Diverse Group and Narrow Racial Disparities. June 14, 2021. https://www.cbpp.org/research/health/closing-medicaid-coverage-gap-would...