A recent study concluded that low-income and uninsured women in states that are not expanding their Affordable Care Act (ACA) Medicaid coverage are less likely to receive breast and cervical cancer screenings compared to states that are implementing expansions, even though such low income people are now given health care coverage under the ACA.

The ACA mandates health coverage for all citizens but states may now broaden Medicaid health insurance coverage for non-elderly adults to those with an annual income up to 133 percent of the federal poverty line. About half of the states have or are expanding their Medicaid eligibility in this way. California, for example, has aggressively expanded coverage and is now projected to have an $80 million shortfall, though the law requires health coverage to be financially viable and self-sustaining.

Lindsay Sabik, Ph.D., a member of the Cancer Prevention and Control research program at 
Virginia Commonwealth University Massey Cancer Center
and the study's lead author and colleagues Dr. Cathy Bradley of Massey and Wafa Tarazi, a doctoral candidate and graduate research assistant at the VCU School of Medicine, looked at the potential impact of the ACA on women's cancer screenings for low-income and uninsured populations in the states implementing expansion and the states that are not.

Using pre-ACA, self-reported data from the 2012 Behavioral Risk Factor Surveillance System (BRFSS), the team analyzed differences of income, race and ethnicity for women ages 52-64 years who followed U.S. Preventive Services Task Force guidelines and underwent a mammogram within two years, and women ages 24-64 years who followed the task force's recommendations and had Pap tests performed within three years. The BRSS is a telephone survey conducted in all 50 states by the U.S. Centers for Disease Control to collect public health data.

The researchers found that women who do not have health insurance are significantly less likely to get regular mammograms and Pap tests. The study results suggest that uninsured women in non-expansion states are less likely to receive potentially lifesaving breast and cervical cancer screenings by 7.9 percent and 4.9 percent, respectively.

Sabik points out that as Medicaid coverage expands and women in non-expansion states, who are more likely to be low-income and African American than in expansion states, continue to lack health insurance coverage, the disparities in breast and cervical cancer screenings may continue to widen. She advises that nonexpansion states should pay attention to existing disparities in preventative care across populations. She suggests that officials consider the costs and benefits of Medicaid expansion for these groups and whether the expansion might narrow the gap in coverage for potentially life-saving breast and cervical screenings.

This study was supported by a National Institutes of Health grant No. R01CA178980, co-funded by the National Cancer Institute and the Office of Behavioral and Social Sciences Research, and, in part, by VCU Massey Cancer Center's NIH-NCI Cancer Center Support Grant P30 CA016059.