The potential impact of the Affordable Care Act and Medicaid expansion on reducing colorectal cancer screening disparities in African American males
Wizdom Powell aff001; Leah Frerichs aff002; Rachel Townsley aff003; Maria Mayorga aff003; Jennifer Richmond aff004; Giselle Corbie-Smith aff005; Stephanie Wheeler aff002; Kristen Hassmiller Lich aff002
Působiště autorů: Health Disparities Institute and Department of Psychiatry, University of Connecticut, Farmington, CT, United States of America aff001; Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America aff002; Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, NC, United States of America aff003; Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America aff004; Center for Health Equity Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America aff005; Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America aff006; Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America aff007
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
Few investigations have explored the potential impact of the Affordable Care Act on health disparity outcomes in states that chose to forgo Medicaid expansion. Filling this evidence gap is pressing as Congress grapples with controversial healthcare legislation that could phase out Medicaid expansion. Colorectal cancer (CRC) is a commonly diagnosed, preventable cancer in the US that disproportionately burdens African American men and has substantial potential to be impacted by improved healthcare insurance coverage. Our objective was to estimate the impact of the Affordable Care Act (increasing insurance through health exchanges alone or with Medicaid expansion) on colorectal cancer outcomes and economic costs among African American and White males in North Carolina (NC), a state that did not expand Medicaid. We used an individual-based simulation model to estimate the impact of ACA (increasing insurance through health exchanges alone or with Medicaid expansion) on three CRC outcomes (screening, stage-specific incidence, and deaths) and economic costs among African American and White males in NC who were age-eligible for screening (between ages 50 and 75) during the study period, years of 2013–2023. Health exchanges and Medicaid expansion improved simulated CRC outcomes overall, though the impact was more substantial among AAs. Relative to health exchanges alone, Medicaid expansion would prevent between 7.1 to 25.5 CRC cases and 4.1 to 16.4 per 100,000 CRC cases among AA and White males, respectively. Our findings suggest policies that expanding affordable, quality healthcare coverage could have a demonstrable, cost-saving impact while reducing cancer disparities.
African American people – Colorectal cancer – Health care policy – Health insurance – Health screening – Oncology – Screening guidelines – Simulation and modeling
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