Karen Taylor, 51, credits Kentucky’s decision to expand Medicaid eligibility under the Affordable Care Act with saving her life.
Taylor rarely had any health insurance before former Gov. Steve Beshear expanded the federal insurance program in 2014. Last year, she had her first colon cancer screening, which found and removed several potentially cancerous polyps.
“Before, I would not have been able to do it (the screening),” Taylor said recently. “If it wasn’t for the insurance, I would have never known.”
Colon cancer is one of the most deadly diseases in Kentucky, which is currently ranked first in the nation for occurrence and fifth for the rate of death from the disease.
After Medicaid expansion, the number of colon cancer screenings for newly insured patients like Taylor went up. And because early stage cancers were caught, the risk of death went down, according to a new study from the University of Kentucky.
In 2011, 14 percent of Kentuckians had no health insurance, a number that dropped to six percent by 2016. During that same time, the number of Medicaid patients who got colon cancer screenings soared by 230 percent and there was a 27 percent decrease in the risk of death from the disease statewide.
In Appalachian Kentucky, where cancer rates are the highest in the state, colon cancer screenings went up 43 percent and the risk of death declined by the same 27 percent. Researchers also noticed a 9.3 percent increase in Eastern Kentucky in early stage diagnosis of colon cancer, when it’s most treatable. Outside of Eastern Kentucky, those diagnosis rates remained about the same.
The data used in the study came from the Kentucky Cabinet for Health and Family Services and the Kentucky Cancer Registry.
“Colorectal screening does save lives,” said Avinash Bhakta, a colorectal surgeon at the UK Markey Cancer Center and lead author on the study, which was published in the Journal of the American College of Surgeons. “By removing one common barrier, we saw an uptick in screening and a huge increase in survival, especially within our Eastern Kentucky population.”
Bhakta declined to comment on Gov. Matt Bevin’s plan to add premiums, work requirements and monthly check-ins for able-bodied adults on Medicaid. The proposal has been held up in federal court after a lawsuit by patients who claim the plan would deprive Kentucky’s most vulnerable citizens of health insurance.
Bevin’s office did not respond to requests for comment.
“The study shows that not only does Medicaid expansion mean more people are able to go to the doctor, but that doing so is making them healthier,” said Jason Bailey, executive director of the liberal-leaning Kentucky Center for Economic Policy. “They are able to get screenings for things like colon cancer that are resulting in lives being saved. That’s a tremendous accomplishment. The barriers to Medicaid that the state is trying to implement would turn all this progress back by taking away health coverage from many thousands of Kentuckians.”
Kentucky has taken a strong stance against colon cancer since 2001, when it first hit number one status for occurrence of the disease, said Tom Tucker, associate director for cancer prevention and control at UK’s Markey Cancer Center and an investigator for the Kentucky Cancer Consortium.
Reseachers and policy experts from UK and the University of Louisville helped set up community-based cancer councils who helped people get screenings, even in rural areas. In 2001, only 34.7 of the population above 50 years old had gotten a screening and by 2008, the number was 63.8 percent.
“There’s no question we’ve had a remarkable impact,” he said.
But the ACA study is important, Tucker said, because it showed how Medicaid expansion captured a population of people who are sometimes called the “working poor,” people who had too much money to qualify for Medicaid, but not enough to have health insurance.
“We expanded those working poor into Medicaid so now they have opportunity to take advantage of colon cancer screenings, and it appears they did,” Tucker said. “That had a significant impact on survival and who has been screened.”
Another study, released Tuesday by Kentucky Voices for Health, found a host of improvements in preventative health care after the Medicaid expansion, including a 111 percent increase in cholesterol screening, a 116 percent increase in preventive dental services; an 88 percent increase in cervical cancer screenings and a 69 percent increase in enrollment in smoking cessation programs.
Screenings not only prevent cancer from ever happening, they also allow doctors to identify early stage cancers, which are much easier to treat successfully.
“Go and get screened because you just never know,” Taylor said. “You can maybe catch it before it gets further along, so it’s best to go when you’ve got the opportunity to do it.”