Study results show breast cancer survival rates are higher in Medicaid expansion states

Roger Williams Medical Center in Providence, Rhode Island. A fresh study shows that women with breast cancer living in Rhode Island and other states that expanded Medicaid eligibility had a lower risk of dying from the disease. (Photo by Michael Salerno/Rhode Island Current)

Women with breast cancer who lived in states that expanded Medicaid eligibility had a lower risk of dying from the disease — but not everyone benefited equally, they say a recent study published in the medical journal JAMA Network Open.

Researchers from Howard University, the University of Alabama, Henry Ford Hospital in Michigan and others examined data from about 1.6 million women ages 40 to 64 who were diagnosed with breast cancer between 2006 and 2021.

They compared survival rates for women living in states that expanded Medicaid eligibility under the Affordable Care Act, commonly known as Obamacare, with rates in states that did not. About 58% of women lived in expansion states and about 42% lived in non-expansion states. States began expanding Medicaid in 2014.

The researchers found that Medicaid expansion was associated with lower all-cause mortality regardless of the women’s disease stage, race or ethnicity, or neighborhood income. Women in expansion stages, whose cancer had spread to other organs – the most advanced stage of the disease – saw the most significant decline in deaths.

Among racial and ethnic groups, the largest relative gains were among Hispanic women – who were 19% less likely to die if they lived in an expansion state. There were smaller increases among non-Hispanic black women and residents of low-income areas. The smallest difference was among white women.

The vast increases in Hispanic women may be due to the fact that many previously had no insurance, Dr. Oluwasegun Akinyemi, a research associate at the Clive O. Callender Outcomes Research Center at Howard University College of Medicine and co-author of the study.

Black women have a higher mortality rate from breast cancer compared to white women, although there are fewer cases among them, in part because they are often diagnosed with the disease at a later stage.

Overall, Black women with breast cancer benefited less from Medicaid expansion than other groups because they disproportionately live in the South, where most states have not expanded, Akinyemi noted. States opposing expansion include Alabama, Florida, Georgia, Mississippi, South Carolina, Tennessee and Texas.

The remaining three non-expansion states are Kansas, Wisconsin and Wyoming.

The researchers also compared mortality rates in low- and high-income neighborhoods. Women who lived in the highest-income neighborhoods and women who received immunotherapy had lower mortality rates. Akinyemi said the finding suggests that coverage leads to better access to treatment.

In July, President Donald Trump signed a sweeping tax and spending bill that will cut federal Medicaid funding by more than $900 billion over the next decade. As a result, about 15 million people could lose Medicaid coverage Estimates from the Center on Budget and Policy Priorities.

Editor’s note: Due to inexact information provided to Stateline, an earlier version of this story omitted Dr. Oluwasegun Akinyemi misrepresented. Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org.