Journal of Cancer Survivorship

, Volume 10, Issue 3, pp 583–592 | Cite as

Medicaid expansion and access to care among cancer survivors: a baseline overview

  • Wafa W. TaraziEmail author
  • Cathy J. Bradley
  • David W. Harless
  • Harry D. Bear
  • Lindsay M. Sabik



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.

Implications for Cancer Survivors

Existing disparities in access to care are likely to widen between cancer survivors in Medicaid non-expansion and expansion states.


Medicaid expansion Cancer survivors Access to care Disparities 



This study was supported under a graduate training fellowship in disparities research from the Susan G. Komen Breast Cancer Foundation (GTDR14302086, PI Sabik). The research was also supported by the Massey Cancer Center.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.


  1. 1.
    Centers for Disease Control and Prevention Addressing the cancer burden at a glance. Available from:
  2. 2.
    American Cancer Society Cancer Facts and figures 2014. Available from:
  3. 3.
    Erikson C, Salsberg E, Forte G, Bruinooge S, Goldstein M. Future supply and demand for oncologists: challenges to assuring access to oncology services. J Oncol Pract. 2007;3:79–86.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    McCabe MS, Jacobs LA. Clinical update: survivorship care—models and programs. Semin Oncol Nurs. 2012;28:e1–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Earle CC. Failing to plan is planning to fail: improving the quality of care with survivorship care plans. J Clin Oncol Off J Am Soc Clin Oncol. 2006;24:5112–6.CrossRefGoogle Scholar
  6. 6.
    Mayer EL, Gropper AB, Neville BA, Partridge AH, Cameron DB, Winer EP, et al. Breast cancer survivors’ perceptions of survivorship care options. J Clin Oncol. 2012;30:158–63.CrossRefPubMedGoogle Scholar
  7. 7.
    Earle CC, Burstein HJ, Winer EP, Weeks JC. Quality of non-breast cancer health maintenance among elderly breast cancer survivors. J Clin Oncol Off J Am Soc Clin Oncol. 2003;21:1447–51.CrossRefGoogle Scholar
  8. 8.
    Yabroff RK, Short PF, Machlin S, Dowling E, Rozjabek H, Li C, et al. Access to preventive health care for cancer survivors. Am J Prev Med. 2013;45:304–12.CrossRefPubMedCentralGoogle Scholar
  9. 9.
    Kent EE, Forsythe LP, Yabroff KR, Weaver KE, Moor JS, Rodriguez JL, et al. Are survivors who report cancer‐related financial problems more likely to forgo or delay medical care? Cancer. 2013;119:3710–7.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Weaver KE, Rowland JH, Bellizzi KM, Aziz NM. Forgoing medical care because of cost: assessing disparities in healthcare access among cancer survivors living in the United States. Cancer. 2010;116:3493–504.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Centers for Disease Control and Prevention The National Action Plan for Cancer Survivorship. Available from:
  12. 12.
    American Society of Clinical Oncology Follow-up Care for Breast Cancer. Available from:
  13. 13.
    Earle CC, Neville BA. Under use of necessary care among cancer survivors. Cancer. 2004;101:1712–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Dulko D, Pace CM, Dittus KL, Sprague BL, Pollack LA, Hawkins NA, et al. Barriers and facilitators to implementing cancer survivorship care plans. Oncol Nurs Forum. 2013;40:575–80.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Steinberg ML. Inequity in cancer care: explanations and solutions for disparity. Semin Radiat Oncol. 2008;18:161–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Pisu M, Martin MY, Shewchuk R, Meneses K. Dealing with the financial burden of cancer: perspectives of older breast cancer survivors. Support Care Cancer. 2014;22:3045–52.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Kaiser Family Foundation A look at Section 1115 Medicaid demonstration waivers under the ACA: a focus on childless adults. Available from:
  18. 18.
    Paradise J Medicaid moving forward. Kaiser Family Foundation. Available from:
  19. 19.
    Antos J. The Medicaid expansion is not such a good deal for states or the poor. J Health Polit Policy Law. 2013;38:179–86.CrossRefPubMedGoogle Scholar
  20. 20.
    Kaiser Family Foundation Medicaid and the Uninsured The uninsured and the difference health insurance makes. Available from:
  21. 21.
    Gottlieb S Medicaid is worse than no coverage at all. Available from:
  22. 22.
    Coughlin TA, Long SK, Shen Y. Assessing access to care under Medicaid: evidence for the nation and thirteen states. Health Aff. 2005;24:1073–83.CrossRefGoogle Scholar
  23. 23.
    Long SK, Coughlin T, King J. How well does Medicaid work in improving access to care? Health Serv Res. 2005;40:39–58.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Sommers BD, Baicker K, Epstein AM. Mortality and access to care among adults after state Medicaid expansions. N Engl J Med. 2012;367:1025–34.CrossRefPubMedGoogle Scholar
  25. 25.
    Garfield R, Damico A, Stephens J, Rouhani S The coverage gap: uninsured poor adults in states that do not expand Medicaid. Kaiser Family Foundation. Available from:
  26. 26.
    American College of Surgeons Commission on Cancer: Cancer Program Standards 2012: ensuring patient-centered care. Available from:
  27. 27.
    Horning SJ. Follow-up of adult cancer survivors: new paradigms for survivorship care planning. Hematol Oncol Clin North Am. 2008;22:201–10.CrossRefPubMedGoogle Scholar
  28. 28.
    Balogh EP, Ganz PA, Murphy SB, Nass SJ, Ferrell BR, Stovall E. Patient-centered cancer treatment planning: improving the quality of oncology care. Summary of an Institute of Medicine Workshop. Oncologist. 2011;16:1800–5.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Khan NF, Evans J, Rose PW. A qualitative study of unmet needs and interactions with primary care among cancer survivors. Br J Cancer. 2011;105:S46–51.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Friese C, Martinez K, Abrahamse P, Hamilton A, Graff J, Jagsi R, et al. Providers of follow-up care in a population-based sample of breast cancer survivors. Breast Cancer Res Treat. 2014;144:179–84.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Miedema B, Easley J. Barriers to rehabilitative care for young breast cancer survivors: a qualitative understanding. Support Care Cancer. 2012;20:1193–201.CrossRefPubMedGoogle Scholar
  32. 32.
    Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System Overview: BRFSS 2012. Available from:
  33. 33.
    U.S. Department of Health & Human Services Poverty guidelines, research and measurement. Available from:
  34. 34.
    Department of Health and Human Services Area Health Resources Files. Available from:
  35. 35.
    Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System. Available from:
  36. 36.
    Centers for Medicare and Medicaid Services State Medicaid and CHIP Policies for 2014. Available from:
  37. 37.
    National Cancer Institute Cancer Health Disparities. Available from:
  38. 38.
    Hong S, Nekhlyudov L, Didwania A, Olopade O, Ganschow P. Cancer survivorship care: exploring the role of the general internist. J Gen Intern Med. 2009;24:495–500.CrossRefPubMedCentralGoogle Scholar
  39. 39.
    Ng AK, Travis LB. Second primary cancers: an overview. Hematol Oncol Clin North Am. 2008;22:271–89.CrossRefPubMedGoogle Scholar
  40. 40.
    American Cancer Society Cancer treatment and survivorship facts and figures 2014–2015. Available from:
  41. 41.
    Wherry LR. Medicaid family planning expansions and related preventive care. Am J Public Health. 2013;103:1577–82.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Weissman JS, Zaslavsky AM, Wolf RE, Ayanian JZ. State Medicaid coverage and access to care for low-income adults. J Health Care Poor Underserved. 2008;19:307–19.CrossRefPubMedGoogle Scholar
  43. 43.
    Adams EK, Kenney GM, Galactionova K. Preventive and reproductive health services for women: the role of California’s family planning waiver. Am J Health Promot. 2013;27:1–10.CrossRefGoogle Scholar
  44. 44.
    Centers for Disease Control and Prevention Survey Data and Documentation. Available from:

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Wafa W. Tarazi
    • 1
    Email author
  • Cathy J. Bradley
    • 2
  • David W. Harless
    • 3
  • Harry D. Bear
    • 4
  • Lindsay M. Sabik
    • 1
  1. 1.Department of Health Behavior and Policy, School of MedicineVirginia Commonwealth UniversityRichmondUSA
  2. 2.University of Colorado Cancer CenterAuroraUSA
  3. 3.School of BusinessVirginia Commonwealth UniversityRichmondUSA
  4. 4.School of MedicineVirginia Commonwealth UniversityRichmondUSA

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