Providence-led research finds Medicaid expansion increases certain cancer screenings, which could lead to better outcomes

February 11, 2016

Research led by Providence Health & Services has found Medicaid coverage results in significantly higher rates of several common cancer screenings, especially among women. Cancer screenings are often the best way to catch cancer early, resulting in better outcomes and survival rates.

The study, “What Does Medicaid Expansion Mean for Cancer Screening and Prevention: Results from a Randomized Trial on the Impacts of Acquiring Medicaid Coverage,” has been posted online and was published in the journal Cancer.

Using a randomized controlled trial of people seeking health coverage, researchers sought answers to two questions: Would Medicaid coverage cause individuals to seek cancer screenings, and would they adopt preventative health behaviors that might reduce cancer risk?

“Getting more people into screenings and preventive care is a key goal of the insurance expansions embedded in the Affordable Care Act,” said Bill Wright, Ph.D., Providence Center for Outcomes Research and Education senior research scientist and study author. “More screenings might mean earlier detection, which could lead to more cost effective care and better treatment and health outcomes for patients.”

The study found having Medicaid coverage did result in people having several types of common cancer screenings, including for cervical cancer (19 percentage points higher than non-covered individuals) and colon cancer (10 percentage points higher than non-covered individuals). However, Medicaid coverage did not significantly impact other screenings, including for prostate or breast cancer, or HPV vaccinations.

Researchers did find the effects of insurance were most evident among women who were thought to be higher risk for cancer by family or personal history. Having insurance significantly increased three of the four female-specific screening rates for women in this group, including breast examinations (26 percent higher), Pap smears for cervical cancer (21 percent higher) and HPV vaccinations (4 percent higher).

“It is particularly important for our highest risk women to be screened for cancers, and this illustrates the impact that insurance may have on emphasizing that,” said Alison Conlin, M.D., Providence Cancer Center oncologist and study author. “It is encouraging to see that these vulnerable women having improved cancer screening and therefore hopefully earlier diagnoses.”

While having coverage did substantially improve connections to primary care physicians, the study found little evidence that those connections resulted in healthier behaviors, such as smoking cessation, alcohol use reduction or weight loss.

“It might be that, for people who have just acquired insurance, these larger lifestyle changes are still a bit down the road,” Wright said. “People who have been without coverage may have been experiencing all kinds of unmet care needs, and may prioritize getting those immediate issues taking care of when they do gain coverage.”

Providence researchers were able to conduct this unique study with the cooperation of the State of Oregon. In 2008, Oregon held a lottery to accept additional low-income, uninsured residents into its Medicaid program. Nearly 90,000 people applied for the 10,000 available openings. The researchers collected data on the lottery participants from many sources, including hospital records and mail surveys, and compared outcomes between those randomly selected by the lottery and those not selected in order to determine the impact of Medicaid coverage. Medicaid, which is jointly funded by the federal and state governments, covers the health care costs of eligible low-income individuals and families.

Earlier research on this randomized controlled trial found that individuals who had access to health care fared better than those who did not. That study was released in 2011 as working paper 17190, and can be found at

The research team included Wright, Conlin, Heidi Allen, Ph.D., Columbia University; Jennifer Tsui, Ph.D., Rutgers Cancer Institute of New Jersey; Matthew Carlson, Ph.D., Portland State University, and Hsin Fang Li, Ph.D., Providence Health &Services. The project was funding by a grant from the American Cancer Society, however the American Cancer Society was not involved in any aspect of the study itself.