The 2001 New York state Medicaid expansion -- considered a precursor to the Affordable Care Act -- widened the racial disparity gap when it came to access to high-quality hospitals for cancer surgery, according to a new study from Georgetown University.
The finding came as a surprise. The researchers expected to see a shrinking racial gap, but instead found the proportion of minority Medicaid patients treated at hospitals that provide high-quality cancer surgery fell significantly compared to their white counterparts.
[Also: Black patients fare better in hospitals that routinely treat diverse populations, study finds]
The New York State Medicaid expansion was the largest in U.S. history before passage of the ACA, which has increased Medicaid enrollment in 32 states as well as the District of Columbia.
The Journal of the American College of Surgeons study included 67,685 patients, of which 15 percent were Medicaid beneficiaries or uninsured. Only 12 percent of the Medicaid beneficiaries were black and 67 percent were non-Hispanic white.
Results showed that over a 21-month period following the state's Medicaid expansion, racial disparity increased by 18 percentage points in hospitals with the highest volume of cancer surgeries performed -- an indicator of quality of surgical cancer care. Racial disparity in access to low-mortality hospitals, another quality measure, showed a similar pattern, increasing by 10 percentage points.
These disparities did not occur because of Medicaid insurance status, however. Researchers found access to Medicaid patients had increased at these hospitals. The researchers say the reason appears to be because, relative to the expansion, more white Medicaid patients and fewer black patients received cancer surgery at high-volume hospitals.
Researchers said the phenomenon may be playing out through the ACA's Medicaid expansion, but this potential issue has not yet been studied.
The study focused on measuring and quantifying this issue, so reasons behind these widened disparities have yet to be discovered. The authors speculate these aggravated disparity trends could be due to multiple factors, including hospital factors (regionalization of specialty care that crowds out some black Medicaid patients), physician factors (referral patterns) or patient factors ( the desire to be treated at more local hospitals rather than regional centers).
This study follows a finding in January 2017 that New York's Medicaid expansion improved access to cancer surgery for the previously uninsured, but did not preferentially benefit ethnic and racial minorities who are typically the most vulnerable of America's poorest populations. That study was also published in JACS.
Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com