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ORIGINAL RESEARCH article

Front. Oncol.
Sec. Breast Cancer
Volume 14 - 2024 | doi: 10.3389/fonc.2024.1460714

Comparative Impact of the Affordable Care Act on Breast Cancer Outcomes Among Women in Two US States

Provisionally accepted
Oluwasegun Akinyemi Oluwasegun Akinyemi 1*Mojisola Fasokun Mojisola Fasokun 2Terhas Weldeslase Terhas Weldeslase 1Eunice Odusanya Eunice Odusanya 1Irene Akinyemi Irene Akinyemi 3Kailyn Geter Kailyn Geter 1Meghana Akula Meghana Akula 1Miriam Michael Miriam Michael 1Kakra Hughes Kakra Hughes 1Robin Williams Robin Williams 1
  • 1 College of Medicine, Howard University, Washington DC, United States
  • 2 University of Alabama at Birmingham, Birmingham, Alabama, United States
  • 3 Spoon River College, Canton, New York, United States

The final, formatted version of the article will be published soon.

    INTRODUCTION: Since the implementation of the Patient Protection and Affordable Care Act (ACA) and Medicaid expansion, states that adopted the policy have seen reduced uninsured rates. However, it is unclear whether increased healthcare access, particularly for minority and socioeconomically disadvantaged groups, has translated into measurable improvements in health outcomes.OBJECTIVE: Our study aims to evaluate the impact of the ACA and Medicaid expansion on breast cancer outcomes in Louisiana, which has implemented the policy, compared to Georgia, which has not, as of 2024.METHODOLOGY: We conducted a retrospective study using SEER registry data from January 2011 to December 2021, including women aged 18-64 diagnosed with breast cancer. The impact of the ACA and Medicaid expansion on cancer-specific survival (CSS), overall survival (OS), and stage at presentation was evaluated. The cohort was divided into pre-ACA (2011-2015) and post-ACA (2017-2021) periods, with a one-year washout (2016). A difference-in-difference (DID) approach compared outcomes between Louisiana and Georgia.The study analyzed 62,381 women with breast cancer, with 32,220 cases in the pre-ACA period (51.7%) and 30,161 in the post-ACA period (48.3%). In Georgia, 43,279 women were included (52.3% pre-ACA vs. 47.7% post-ACA), while Louisiana had 19,102 women (50.1% pre-ACA vs. 49.9% post-ACA). Medicaid expansion in Louisiana was associated with a 0.26 percentage point reduction in overall deaths (95% CI: -10.9 to 10.4) and a 5.97 percentage point reduction in cancer-specific mortality (95% CI: -26.1 to 14.2). There was also no significant difference in disease stage at presentation compared to Georgia.CONCLUSION: This study found no significant differences in overall mortality, cancer-specific mortality, or disease stage at presentation among women with breast cancer in Louisiana, which implemented Medicaid expansion in 2016, compared to Georgia, which has not expanded Medicaid.

    Keywords: Georgia, Louisiana, Affordable Care Act, Medicaid expansion, OVERALL MORTALITY, Cancer-specific mortality, Inverse probability of treatment weighting, Difference - In - Differences

    Received: 06 Jul 2024; Accepted: 14 Oct 2024.

    Copyright: © 2024 Akinyemi, Fasokun, Weldeslase, Odusanya, Akinyemi, Geter, Akula, Michael, Hughes and Williams. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Oluwasegun Akinyemi, College of Medicine, Howard University, Washington DC, United States

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.