MG-SORC Research Finds Unexpected Results on Medicaid Expansion and Reduction of Disparity in Access

Surgeons in green scubs working on patient in operating room.

The research team from the MedStar-Georgetown Surgical Outcomes Research Center (MG-SORC) recently published their findings on mixed effects on pre-ACA Medicaid expansion on access to surgical cancer care at high-quality hospitals.

“Medicaid Expansion and Disparity Reduction in Surgical Cancer Care at High Quality Hospitals” was published in the Journal of the American College of Surgeons. The research was based data from the 2001 New York State Medicaid expansion, which is considered a precursor to the Affordable Care Act. 

David Xiao, a health justice scholar at Georgetown University School of Medicine, is the first author on the study. Xiao's work was sponsored by the MedStar Summer Research Program, under the mentorship of Waddah B. Al-Refaie, MD, FACS. Additional co-authors are Chaoyi Zheng, MS; Manila Jindal, BS; Lynt B. Johnson, MD, MBA, FACS; Thomas DeLeire, PhD; Nawar Shara, PhD.

The research identified 67,685 nonelderly adults from the New York State Inpatient Database, who underwent specific cancer surgeries. High-quality hospitals were defined as high-volume or low-mortality hospitals. Disparity was defined in this research as the model-adjusted difference in the percentage of patients operated at high-quality hospitals by insurance type (Medicaid/uninsured vs. privately insured) or by race (African-American vs. white).

The results found that the disparity in access to high-volume hospitals by insurance type was reduced by 0.97 % points per quarter following the expansion. Medicaid/uninsured beneficiaries had similar access to low-mortality hospitals as the privately insured, showing no significant change was detected around expansion. In contrast, racial disparity increased by 0.87% points per quarter in access to high-volume hospitals and by 0.48% points per quarter in access to low-mortality hospitals following Medicaid expansion.

These findings show that the Medicaid expansion reduced the disparity in access to surgical cancer care at high-volume hospitals by payer. However, it was associated with the increased racial disparity in access to high-quality hospitals.

This research was also presented at the 12th Annual Academic Surgical Congress and nominated for “Outstanding Medical Student Award”.

This research follows Dr. Al-Refaie’s earlier findings, 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.

MG-SORC is a coalition of surgeons, other clinicians, and scientists committed to contributing to the scientific mission of Georgetown University Medical Center and MedStar Health by advancing the efficient and effective delivery of surgical care in the United States.

Journal of the American College of Surgeons, 2017. DOI: 10.1016/j.jamcollsurg.2017.09.012