Has Medicaid expansion improved rates of colorectal cancer screening?

In the January issue of Diseases of the Colon & Rectum, Dr. Zerhouni and colleagues from Brigham & Women’s Hospital in Boston, MA, sought to answer this question using data from health-related telephone surveys administered by the Centers for Disease Control (CDC).

Every 2 years, these surveys (the Behavioral Risk Factor Surveillance System [BRFSS]) ask questions regarding preventative cancer screening. The authors used survey data from 2012, 2014, and 2016 to see whether Medicaid expansion as a result of the Affordable Care Act was associated with an increased rate of colorectal cancer screening.

Three groups of states were compared: those who adopted Medicaid expansion prior to 2014 (Early Expansion), those who expanded Medicaid in 2014, and those who did not expand Medicaid. Colorectal cancer screening rates in all expansion states were higher than in non-expansion states. This was significantly higher when early expansion states were compared to non-expansion states. Low-income individuals from early expansion states also had significantly higher screening rates than those from non-expansion states. Colorectal cancer screening rates in African Americans increased in early expansion states compared to non-expansion states, while screening rates for Hispanics did not change significantly.

Dr. Zerhouni emphasizes that Medicaid expansion has accelerated the uptake of colorectal screening in all early Medicaid expansion states, particularly among low-income individuals and African Americans and that targeted outreach may be necessary for certain populations.