title: Medicaid Coverage Expansion and Implications for Cancer Disparities.
abstract: OBJECTIVE
  We estimated the impact on cancer disparities in US states that have chosen or not chosen to expand Medicaid since passage of the Patient Protection and Affordable Care Act.
  
  
  METHODS
  Data came from the 2013 Uniform Data System for colorectal and cervical cancer screening rates among patients of federally qualified health centers (FQHCs); the 2012 Behavioral Risk Factor Surveillance System for colorectal, cervical, and breast cancer screening rates; and the US Cancer Statistics (2007-2011) for colorectal, cervical, and breast cancer mortality-to-incidence ratios (MIRs). Dyads of Medicaid expansion decisions with cancer screening rates and MIRs were mapped using ArcMap.
  
  
  RESULTS
  States that had not expanded Medicaid as of September 2014 had lower cancer screening rates, especially among FQHC patients. Overall, cancer MIRs were not significantly different by Medicaid expansion status. However, Southeastern states without Medicaid expansion tended to have higher cancer MIRs and lower screening rates.
  
  
  CONCLUSIONS
  Disparities in cancer screening that already disfavor states with high cancer rates may widen in states that have not chosen to expand Medicaid unless significant efforts are mounted to ensure their residents obtain preventive health care.
authors.affiliation: Seul Ki Choi, Swann Arp Adams, Jan M. Eberth, Heather M. Brandt, Daniela B. Friedman, and James R. Hébert are with the Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia. Reginald D. Tucker-Seeley is with the Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA. Mei Po Yip is with the Division of General Internal Medicine, University of Washington, Seattle.
authors.forename: Seul Ki
authors.initials: SK
authors.lastname: Choi
authors.affiliation: Seul Ki Choi, Swann Arp Adams, Jan M. Eberth, Heather M. Brandt, Daniela B. Friedman, and James R. Hébert are with the Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia. Reginald D. Tucker-Seeley is with the Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA. Mei Po Yip is with the Division of General Internal Medicine, University of Washington, Seattle.
authors.forename: Swann Arp
authors.initials: SA
authors.lastname: Adams
authors.affiliation: Seul Ki Choi, Swann Arp Adams, Jan M. Eberth, Heather M. Brandt, Daniela B. Friedman, and James R. Hébert are with the Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia. Reginald D. Tucker-Seeley is with the Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA. Mei Po Yip is with the Division of General Internal Medicine, University of Washington, Seattle.
authors.forename: Jan M
authors.initials: JM
authors.lastname: Eberth
authors.affiliation: Seul Ki Choi, Swann Arp Adams, Jan M. Eberth, Heather M. Brandt, Daniela B. Friedman, and James R. Hébert are with the Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia. Reginald D. Tucker-Seeley is with the Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA. Mei Po Yip is with the Division of General Internal Medicine, University of Washington, Seattle.
authors.forename: Heather M
authors.initials: HM
authors.lastname: Brandt
authors.affiliation: Seul Ki Choi, Swann Arp Adams, Jan M. Eberth, Heather M. Brandt, Daniela B. Friedman, and James R. Hébert are with the Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia. Reginald D. Tucker-Seeley is with the Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA. Mei Po Yip is with the Division of General Internal Medicine, University of Washington, Seattle.
authors.forename: Daniela B
authors.initials: DB
authors.lastname: Friedman
authors.affiliation: Seul Ki Choi, Swann Arp Adams, Jan M. Eberth, Heather M. Brandt, Daniela B. Friedman, and James R. Hébert are with the Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia. Reginald D. Tucker-Seeley is with the Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA. Mei Po Yip is with the Division of General Internal Medicine, University of Washington, Seattle.
authors.forename: Reginald D
authors.initials: RD
authors.lastname: Tucker-Seeley
authors.affiliation: Seul Ki Choi, Swann Arp Adams, Jan M. Eberth, Heather M. Brandt, Daniela B. Friedman, and James R. Hébert are with the Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia. Reginald D. Tucker-Seeley is with the Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA. Mei Po Yip is with the Division of General Internal Medicine, University of Washington, Seattle.
authors.forename: Mei Po
authors.initials: MP
authors.lastname: Yip
authors.affiliation: Seul Ki Choi, Swann Arp Adams, Jan M. Eberth, Heather M. Brandt, Daniela B. Friedman, and James R. Hébert are with the Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia. Reginald D. Tucker-Seeley is with the Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA. Mei Po Yip is with the Division of General Internal Medicine, University of Washington, Seattle.
authors.forename: James R
authors.initials: JR
authors.lastname: Hébert
mesh_terms: D000328:Adult; D040343:Behavioral Risk Factor Surveillance System; D001943:Breast Neoplasms / Q000175:diagnosis; D015179:Colorectal Neoplasms / Q000175:diagnosis; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act / Q000331:legislation & jurisprudence; D011787:Quality of Health Care; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis