title: Health Reform, Medicaid Expansions, and Women's Cancer Screening.
abstract: Health reform, including Medicaid expansion, is increasing insurance coverage and financial access to breast and cervical cancer screening for low-income women, although services for low-income uninsured women are still needed.
  
  
  
  American Community Survey and administrative data about Medicaid and health insurance enrollment are used to estimate the number of low-income women who will be uninsured in 2017, focusing on the age ranges 21 to 64, 40 to 64, and 50 to 64.
  
  
  
  Assuming that 29 states expand Medicaid (as of June 2015), the national percentage of low-income women 21 to 64 who are uninsured will fall from 32.2% in 2013 to 14.6% by 2017. Among Medicaid-expanding states, the percentage of uninsured will decrease from 28.7% to 8.0%, whereas in non-expanding states, the level will decrease from 36.9% to 23.3%. About 5.7 million women 21 to 64 and 2.6 million women 40 to 64 will remain uninsured in 2017. The size of the uninsured low-income population will remain much larger than the 659,000 women who have previously received Pap tests and 548,000 obtaining mammograms under the National Breast and Cervical Cancer Early Detection Program in 2013.
  
  
  
  Even before 2014, women living in states that are not expanding Medicaid were less likely to get mammograms and Pap tests than women in expanding states. Affordable Care Act-related insurance expansions will lower financial barriers to screening and should boost overall screening rates. But disparities in insurance coverage and cancer screening across Medicaid-expanding and non-expanding states could widen.
  
  
  
  Programs to support cancer screening for low-income uninsured women will still be needed.
authors.affiliation: Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC. Electronic address: lku@gwu.edu.
authors.forename: Leighton
authors.initials: L
authors.lastname: Ku
authors.affiliation: Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC.
authors.forename: Tyler
authors.initials: T
authors.lastname: Bysshe
authors.affiliation: Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC.
authors.forename: Erika
authors.initials: E
authors.lastname: Steinmetz
authors.affiliation: Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC.
authors.forename: Brian K
authors.initials: BK
authors.lastname: Bruen
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000175:diagnosis / Q000191:economics / Q000517:prevention & control*; D055088:Early Detection of Cancer / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D018166:Health Care Reform; 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; D008327:Mammography / Q000191:economics* / Q000706:statistics & numerical data; D008484:Medicaid / Q000191:economics / Q000331:legislation & jurisprudence*; D017057:Medically Uninsured / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D008875:Middle Aged; D065006:Papanicolaou Test; D058991:Patient Protection and Affordable Care Act / Q000191:economics; D011203:Poverty; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000191:economics / Q000517:prevention & control*; D014626:Vaginal Smears / Q000191:economics* / Q000706:statistics & numerical data