Breast Cancer Coverage from Every Angle

ASBrS 2021: Can Medicaid Expansion Improve Disparities in Breast Reconstruction?

By: Justine Landin, PhD
Posted: Tuesday, May 18, 2021

Medicaid expansion under the Affordable Care Act may improve disparities in breast reconstruction, according to retrospective research findings presented during the virtual edition of the American Society of Breast Surgeons (ASBrS) 2021 Annual Meeting (Abstract 139). In particular, increased access to Medicaid was positively correlated with an improvement in disparities in breast reconstruction for non-Hispanic Black, lower-income, and less-educated patients who underwent mastectomy for breast cancer. According to the researchers, at times, the increase in breast reconstruction in non-Hispanic Black women achieved parity with non-Hispanic White women.

“The study suggests that Medicaid expansion was highly effective in doing what it was supposed to do—breaking down barriers to care,” stated Sharon Lum MD, and colleagues of Loma Linda University Health, California.

Non-Hispanic Black and non-Hispanic White patients with breast cancer (n = 1,196,859) who underwent mastectomy with or without reconstruction were selected from the National Cancer database. Factors such as race/ethnicity, income, education, insurance type, and Medicaid expansion status were associated with breast reconstruction using multivariable logistic regression. Differences between the regression analyses of both groups of patients were compared to determine whether breast reconstruction disparities were related to early (2010 to January 2014), late (after January 2014), or no Medicaid expansion across states.

In general, the proportion of patients who underwent breast reconstruction declined from 2013 to 2017 (P < .0001). Patients who were non-Hispanic White, insured, with higher income or education levels were most likely to undergo breast reconstruction without considering Medicaid expansion. Similarly, in non-expansion states, the proportion of non-Hispanic Black patients to receive reconstruction was significantly lower than their non-Hispanic White counterparts across all years. However, in early expansion states, by 2014, non-Hispanic Black patients were more likely to receive reconstruction than their non-Hispanic White counterparts (+ 0.21%). This disparity was also improved in late expansion states by 2017 (+ 0.19%).

Disclosure: The study authors reported no conflicts of interest.

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