title: Medicaid expansion and access to care among cancer survivors: a baseline overview.
abstract: Medicaid expansion under the Affordable Care Act facilitates access to care among vulnerable populations, but 21 states have not yet expanded the program. Medicaid expansions may provide increased access to care for cancer survivors, a growing population with chronic conditions. We compare access to health care services among cancer survivors living in non-expansion states to those living in expansion states, prior to Medicaid expansion under the Affordable Care Act.
  
  
  
  We use the 2012 and 2013 Behavioral Risk Factor Surveillance System to estimate multiple logistic regression models to compare inability to see a doctor because of cost, having a personal doctor, and receiving an annual checkup in the past year between cancer survivors who lived in non-expansion states and survivors who lived in expansion states.
  
  
  
  Cancer survivors in non-expansion states had statistically significantly lower odds of having a personal doctor (adjusted odds ratio [AOR] 0.76, 95 % confidence interval [CI] 0.63-0.92, p < 0.05) and higher odds of being unable to see a doctor because of cost (AOR 1.14, 95 % CI 0.98-1.31, p < 0.10). Statistically significant differences were not found for annual checkups.
  
  
  
  Prior to the passage of the Affordable Care Act, cancer survivors living in expansion states had better access to care than survivors living in non-expansion states. Failure to expand Medicaid could potentially leave many cancer survivors with limited access to routine care.
  
  
  
  Existing disparities in access to care are likely to widen between cancer survivors in Medicaid non-expansion and expansion states.
authors.affiliation: Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, 830 East Main St., P.O. Box 980430, Richmond, VA, 23298, USA. taraziw@vcu.edu.
authors.forename: Wafa W
authors.initials: WW
authors.lastname: Tarazi
authors.affiliation: University of Colorado Cancer Center, Aurora, CO, USA.
authors.forename: Cathy J
authors.initials: CJ
authors.lastname: Bradley
authors.affiliation: School of Business, Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Harless
authors.affiliation: School of Medicine, Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: Harry D
authors.initials: HD
authors.lastname: Bear
authors.affiliation: Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, 830 East Main St., P.O. Box 980430, Richmond, VA, 23298, USA.
authors.forename: Lindsay M
authors.initials: LM
authors.lastname: Sabik
mesh_terms: D000293:Adolescent; D000328:Adult; D040343:Behavioral Risk Factor Surveillance System; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility / Q000331:legislation & jurisprudence / Q000592:standards / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000191:economics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008484:Medicaid / Q000592:standards / Q000706:statistics & numerical data / Q000639:trends; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000534:rehabilitation*; D058991:Patient Protection and Affordable Care Act; D017741:Survivors / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Access to care; Cancer survivors; Disparities; Medicaid expansion