Uninsured women are less likely to get preventive care than women who have health insurance. For women who live in states that did not expand Medicaid under the Affordable Care Act (ACA), that poses a significant problem.
According to a study from Virginia Commonwealth University Massey Cancer Center, low-income and uninsured women in states that did not expand Medicaid are less likely to have breast and cervical cancer screenings than women in states that did.
That could mean the difference between finding early stage cancer when it’s more easily treatable and finding it after it becomes life threatening.
The United States Preventive Services Task Force (USPSTF) recommends routine mammogram screening every two years beginning at age 50. It recommends routine Pap tests every three years for women aged 21 to 65. Women of other age groups or women at higher risk should discuss screening with their doctors.
Skipping Important Cancer Screenings
The number of insured Americans has grown since the ACA became law. Despite that, millions still can’t afford coverage. This is especially true in the 21 states that refused to expand Medicaid. The law allows states to extend Medicaid coverage to adults with an annual income up to 133 percent of the federal poverty level.
Lindsay Sabik, Ph.D., the Virginia study’s lead author, set out to learn how the Medicaid expansion affects women’s cancer screenings. Sabik and her colleagues used data from the 2012 Behavioral Risk Factor Surveillance System.
They found that uninsured women are less likely to get regular mammograms and Pap tests. Uninsured women in non-expansion states are about 8 percent less likely to have breast screenings. They are about 5 percent less likely to have cervical screenings. Details of the study are published in the American Journal of Preventive Medicine.
Sabik believes breast and cervical cancer screening disparities will continue to widen. Women in some states will gain coverage and get screened. Others will remain uninsured. Those women will continue to face access problems. Women in non-expansion states who continue to be uninsured are more likely to be low-income and African-American.
Waiting Until Symptoms Appear
So, what happens to women who don’t get preventive screenings? Uninsured women may wait until they have obvious symptoms before seeking care.
“They are diagnosed at later stages, and are less likely to receive guideline concordant treatment,” Sabik told Healthline. “We are interested in understanding specifically how Medicaid expansions impact cancer prevention and diagnosis, given poor outcomes among uninsured and low-income populations.”
This study did not specifically investigate what happens to women who don’t receive screening. Sabik said part of the project is still in the early stages.
“We will compare stage at diagnosis for breast cancer cases before and after state-level insurance expansions to low-income women,” she said.
Sabik led another study that looked specifically at Massachusetts. The state enacted its own healthcare law in 2006. Since then, it has achieved near-universal health insurance coverage.
That study showed a rise in breast and cervical cancer screenings.
“The effects were larger a few years after reform than they were immediately after insurance expansions. This suggests there is an adjustment period before we see the full impact of increases in insurance coverage,” said Sabik.
Options for Uninsured and Underinsured Women
Dr. Claudia Mason, board member of Susan G. Komen South Florida, told Healthline that options depend on where you live.
“Low cost or no cost alternatives, such as free clinics or family planning clinics operated by the county health department, are available,” she said. “Others may be able to avail themselves from student health centers or employee clinics.”
When it comes to preventive care, not having health insurance is clearly a problem, but it’s not the only problem. According to Mason, funds are just one barrier to care. Transportation, distance, access, and culture also play a role.
Screening guidelines are good, but access to care is crucial.
“Screening programs are designed to identify disease at an early state,” said Mason. “That’s when interventions are more likely to be less invasive, more effective, and less expensive.”
Sabik calls on non-expansion states to consider disparities in preventive care.
"There's a lot that still needs to be done to make the Medicaid program more consistent across states to give all women fair access to cancer screenings,” she said.