title: The Patient Protection and Affordable Care Act: impact on the care of gynecologic oncology patients in the absence of Medicaid expansion in central Virginia.
abstract: OBJECTIVE
  Many gynecologic oncology (GO) patients in Virginia are low income and their care is supplemented by Disproportionate Share Hospital (DSH) funds. Our objective is to estimate how many new GO patients may lose access to care if the state forgoes Medicaid expansion.
  
  
  METHODS
  New patients referred to the GO service between July 1, 2010 and July 1, 2012 were identified. Data were collected regarding age, race, referral diagnosis, payor, and state pay scale. Pay scale 1 (PS1) is equal to the federal poverty level (FPL). Assumptions included the following: (1) pay scale is a surrogate for income, (2) PS1 patients will be ineligible for discounted insurance through the exchanges, and (3) decreasing DSH funds will result in a reduction of the free-care pool.
  
  
  RESULTS
  There were 1623 referrals to the GO service and the majority (83%) was Caucasian. The payor distribution was 44% commercial insurance, 5.6% Medicaid, 31% Medicare, and 10.4% uninsured. Among the 361 women who were PS1, 32% were uninsured. Thirty percent of PS1 patients were minorities and 47.4% had a malignancy. Of note, 52% of new patients with cervical cancer were PS1.
  
  
  CONCLUSIONS
  Seven percent of new GO patients are PS1 and uninsured. This population contains a disproportionate number of minorities and women with cancer. These women will have difficulty affording care as DSH funding decreases, particularly in states with lean Medicaid that opt out of Medicaid expansion. The burden of lack of access to care will be shouldered by an unfortunate few.
authors: Thornton Gynecology Oncology Service, Department of Obstetrics and Gynecology, University of Virginia Health System, Charlottesville, VA 22908, USA. mbc3fm@virginia.edu
authors: Madeleine
authors: M
authors: Courtney-Brooks
authors: Elizabeth B
authors: EB
authors: Pelkofski
authors: Carolyn L
authors: CL
authors: Engelhard
authors: Linda R
authors: LR
authors: Duska
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005833:Genital Neoplasms, Female / Q000628:therapy*; D006801:Humans; D008484:Medicaid; D017057:Medically Uninsured; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act; D012017:Referral and Consultation; D014481:United States; D014768:Virginia
keywords: Affordable Care Act; Medicaid expansion