title: State Medicaid expansion decisions and disparities in women's cancer screening.
abstract: BACKGROUND
  There are substantial disparities in breast and cervical cancer screening that stem from lack of health insurance. Although the Affordable Care Act (ACA) expands insurance coverage to many Americans, there are differences in availability of Medicaid coverage across states.
  
  
  OBJECTIVE
  To understand the potential impact of Medicaid expansions on disparities in preventive care for low-income women by assessing pre-ACA breast and cervical cancer screening across states currently expanding and not expanding Medicaid to low-income adults.
  
  
  METHODS
  Data from the 2012 Behavioral Risk Factor Surveillance System (analyzed in 2014) were used to consider differences in demographics among women for whom screening is recommended, including income and race/ethnicity, across expansion and nonexpansion states. Self-reported screening was compared by state expansion status overall, for the uninsured, and for low-income women. Logistic regressions were estimated to assess differences in self-reported screening across expansion and nonexpansion states controlling for demographics.
  
  
  RESULTS
  Women in states that are not expanding Medicaid had significantly lower odds of receiving recommended mammograms (OR=0.87, 95% CI=0.79, 0.95) or Pap tests (OR=0.87, 95% CI=0.79, 0.95). The difference was larger among the uninsured (OR=0.72, 95% CI=0.56, 0.91 for mammography; OR=0.78, 95% CI=0.65, 0.94 for Pap tests).
  
  
  CONCLUSIONS
  As women in nonexpansion states remain uninsured and others gain coverage, existing disparities in cancer screening by race and socioeconomic status are likely to widen. Health risks and associated costs to underserved populations must be taken into account in ongoing debates over expansion.
authors.affiliation: Department of Healthcare Policy and Research, Virginia Commonwealth University School of Medicine, Richmond, Virginia. Electronic address: lsabik@vcu.edu.
authors.forename: Lindsay M
authors.initials: LM
authors.lastname: Sabik
authors.affiliation: Department of Healthcare Policy and Research, Virginia Commonwealth University School of Medicine, Richmond, Virginia.
authors.forename: Wafa W
authors.initials: WW
authors.lastname: Tarazi
authors.affiliation: Department of Healthcare Policy and Research, Virginia Commonwealth University School of Medicine, Richmond, Virginia.
authors.forename: Cathy J
authors.initials: CJ
authors.lastname: Bradley
mesh_terms: D000328:Adult; D040343:Behavioral Risk Factor Surveillance System; D001943:Breast Neoplasms / Q000175:diagnosis / Q000191:economics / Q000517:prevention & control*; D055088:Early Detection of Cancer / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence / Q000191:economics / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000191:economics* / Q000331:legislation & jurisprudence; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006801:Humans; D019458:Insurance Coverage / Q000191:economics / Q000331:legislation & jurisprudence; D016015:Logistic Models; D008327:Mammography / Q000191:economics* / Q000706:statistics & numerical data; D008484:Medicaid / Q000191:economics / Q000331:legislation & jurisprudence*; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act / Q000191:economics / Q000592:standards; D012923:Social Class; D013219:State Government; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000191:economics / Q000517:prevention & control*; D014626:Vaginal Smears / Q000191:economics* / Q000706:statistics & numerical data; D055815:Young Adult