Medicaid expansion under the ACA linked to increased palliative care use

Reviewed by Danielle Ellis, B.Sc.Jul 5 2023

More people with advanced cancers in the United States received critical palliative care services, according to new findings by researchers at the American Cancer Society (ACS). Palliative care includes supportive care managed by a healthcare team, such as relief from symptoms, pain, and stress. Researchers also found where a patient lives in the U.S. may determine their use of palliative care. Medicaid expansion under the ACA was associated with the largest increases in palliative care use. The study was published today in the July issue of the journal Health Affairs.

Our findings are encouraging, especially with growing evidence of the important benefits of palliative care for patients with cancer. It's imperative to know how to target ways to increase access to these services, as use, overall, still remains low in the U.S."

Dr. Xuesong Han, lead author of the study and scientific director of health services research at the American Cancer Society

For the study, researchers examined data from the National Cancer Database, a national hospital-based cancer registry jointly sponsored by the American College of Surgeons and ACS. Scientists included data from people aged 18-64 years newly diagnosed with stage IV cancers in 2010-2019.

Researchers discovered the number of eligible patients who received palliative care increased from 17.0 percent pre-expansion to 18.9 percent post-expansion in Medicaid expansion states and from 15.7 percent to 16.7 percent in non-expansion states. The study also showed palliative care associated with Medicaid expansion was largest for patients with advanced pancreatic, colorectal, lung, and oral cavity and pharynx cancers, and non-Hodgkin lymphoma.

"These study results suggest that the expansion of Medicaid coverage may increase palliative care use," added Han. "They also point to a potentially widening geographic disparity in receipt of guideline-recommended palliative care between states with different health policies regarding income-based Medicaid eligibility requirements."

"Research continues to underscore the impact increasing access to comprehensive, affordable health insurance through Medicaid has on cancer patient survival and the further importance of providing greater access to palliative care services to those positive outcomes. The American Cancer Society Cancer Action Network (ACS CAN) has led legislation in states to support palliative care access and continues to advocate for legislation at the federal level to promote increased access to supportive care at any age or stage of diagnosis nationwide," said Lisa Lacasse, President of ACS CAN. "To fully improve patient quality of life, Congress should prioritize legislation that educates patients and providers about the availability and benefits of palliative care and expand federal palliative care research. It's also crucial all remaining states expand access to Medicaid as access to comprehensive health care is key to closing the gap on the health inequities we see in these underserved areas and ensure everyone has a fighting chance against cancer."

Other ACS authors participating in this study include: Sylvia Shi, Jingxuan Zhao, Dr. Leticia Nogueira, Dr. Arif Kamal, Dr. Ahmedin Jemal, and Dr. Robin Yabroff.