title: What does Medicaid expansion mean for cancer screening and prevention? Results from a randomized trial on the impacts of acquiring Medicaid coverage.
abstract: BACKGROUND
  The Oregon Medicaid lottery provided a unique opportunity to assess the causal impacts of health insurance on cancer screening rates within the framework of a randomized controlled trial. Prior studies regarding the impacts of health insurance have almost always been limited to observational evidence, which cannot be used to make causal inferences.
  
  
  METHODS
  The authors prospectively followed a representative panel of 16,204 individuals from the Oregon Medicaid lottery reservation list, collecting data before and after the Medicaid lottery drawings. The study panel was divided into 2 groups: a treatment group of individuals who were selected in the Medicaid lottery (6254 individuals) and a control group who were not (9950 individuals). The authors also created an elevated risk subpanel based on family cancer histories. One year after the lottery drawings, differences in cancer screening rates, preventive behaviors, and health status were compared between the study groups.
  
  
  RESULTS
  Medicaid coverage resulted in significantly higher rates of several common cancer screenings, especially among women, as well as better primary care connections and self-reported health outcomes. There was little evidence found that acquiring Medicaid increased the adoption of preventive health behaviors that might reduce cancer risk.
  
  
  CONCLUSIONS
  Medicaid coverage did not appear to directly impact lifestyle choices that might reduce cancer risk, but it did provide access to important care and screenings that could help to detect cancers earlier. These findings could have long-term population health implications for states considering or pursuing Medicaid expansion. Cancer 2016;122:791-797. © 2015 American Cancer Society.
authors.affiliation: Center for Outcomes Research and Education, Providence Health and Services, Portland, Oregon.
authors.forename: Bill J
authors.initials: BJ
authors.lastname: Wright
authors.affiliation: Department of Medical Oncology, Providence Health and Services, Providence Portland Medical Center, Portland, Oregon.
authors.forename: Alison K
authors.initials: AK
authors.lastname: Conlin
authors.affiliation: School of Social Work, Columbia University, New York, New York.
authors.forename: Heidi L
authors.initials: HL
authors.lastname: Allen
authors.affiliation: Division of Population Sciences, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Tsui
authors.affiliation: Department of Sociology, Portland State University, Portland, Oregon.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Carlson
authors.affiliation: Center for Outcomes Research and Education, Providence Health and Services, Portland, Oregon.
authors.forename: Hsin Fang
authors.initials: HF
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D001943:Breast Neoplasms / Q000175:diagnosis; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis; D051517:Digital Rectal Examination / Q000706:statistics & numerical data; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D015438:Health Behavior; D006297:Health Services Accessibility; D006304:Health Status; D054624:Health Status Disparities; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D008297:Male; D008327:Mammography / Q000706:statistics & numerical data; D008484:Medicaid / Q000706:statistics & numerical data*; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D009780:Occult Blood; D009922:Oregon; D065006:Papanicolaou Test / Q000706:statistics & numerical data; D053918:Papillomavirus Vaccines / Q000627:therapeutic use; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000175:diagnosis; D057566:Self Report; D012737:Sex Factors; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000517:prevention & control; D014626:Vaginal Smears / Q000706:statistics & numerical data; D014850:Waiting Lists; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines
keywords: Medicaid; early detection of cancer; health behavior; health insurance; health status