In less than a year, new Medicaid eligibility restrictions may lead millions of people to lose coverage and then miss potentially lifesaving cancer screenings like colonoscopies or mammograms. A new analysis estimates that Americans may miss more than a million cancer screenings for colorectal, breast, or lung cancer over the two years after the new policy takes effect.
“I see patients every day that come to me with cancer and are asymptomatic, but their life gets turned upside down because they are told they have cancer,” said Adrian Diaz, a surgical oncologist at the University of Chicago and one of the authors on the paper, published Thursday in JAMA Oncology. “In a positive way, we catch it early. It’s potentially treatable, curable. Seeing that number, over a million patients, who will not have that opportunity — I was taken aback.”
Ultimately, the One Big Beautiful Bill will cut an estimated $1 trillion from Medicaid. Republicans pushed for the Medicaid cuts in the bill as a way to help offset the cost of new, large tax cuts, and argued that the cuts were a way to rein in rising Medicaid costs. President Trump signed the bill on July 4th last year over the protests of health groups, advocates, Democrats, and some Republicans, who argued the cuts would lead to millions of people losing insurance and tens of thousands of preventable deaths. The new requirements go into effect Jan. 1, 2027.
To do the analysis, the researchers built a model that was able to estimate the impact of two main new Medicaid eligibility requirements: the work requirement and re-verification of eligibility every six months. To make that model, the researchers used studies analyzing how Medicaid enrollment changed when Arkansas implemented a work requirement in 2018, and also how enrollment changed when re-verification requirements were eased during the Covid-19 pandemic. The team also used sources like the Center for Disease Control and Prevention’s SEER and Behavioral Risk Factor Surveillance System databases for the analysis.
“We designed this study using real world natural experiments and extrapolated that to simulate what that would do to patients when the policy takes effect in 2027,” Diaz said.
STAT Plus: States feel crunch of Medicaid work requirement deadline as they await clarity from CMS
Ultimately, their model predicted the loss of Medicaid coverage, which can happen to individuals for a variety of reasons including administrative burdens and errors, would lead to nearly 1.2 million missed colorectal, breast, or lung cancer screenings and 155 preventable deaths within two years.
STAT spoke with Diaz about the study and the impact that new Medicaid restrictions may have on Americans. This interview has been edited for length and clarity.
Why was this study important to you?
At the end of last year, the current administration passed what they called the One Big Beautiful Bill. Part of that bill, some of the cost savings came from Medicaid. As a cancer doc, most of my patients come to my clinic with a diagnosis of cancer, which is most frequently diagnosed through screening.
I was asking myself and my co-author Sarah Shubeck, who is also a cancer surgeon, this can be detrimental for patients on Medicaid who are at that prime age when screening guidelines start to take effect for colorectal and breast cancer. That’s the same population being targeted by this policy. We worried and still worry that these policies are going to have a deleterious effect for patients and their ability to access cancer screening. Using prior data from these essentially natural experiments from Covid and Arkansas, we sought to model out what would happen nationally for Medicaid beneficiaries in this demographic who are eligible for breast, lung, and colon cancer screening.
The main finding that this policy could lead to 1.2 million missed cancer screenings — those are estimated screenings that Medicaid beneficiaries otherwise would have gotten, but won’t because of this policy?
Yeah, correct. There are a bunch of studies by different groups out there on how many would no longer be eligible for Medicaid coverage. Our numbers line up with the rest of the modeling of expected coverage loss: 7.5 million or so Medicaid beneficiaries. Those numbers are not novel. But we started to model the behaviors and utilization of health care and I saw the number of over a million missed cancer screenings. That really popped out at me. As a researcher, it was bigger than I expected.
How do these policies lead to people losing Medicaid coverage?
I can give you a very basic example. In Medicaid, if you don’t submit your taxes or proof of earnings, you missed that window. Best case scenario, the next window can be in a month. Sometimes it takes more time. It can be several months. Sometimes I hear people say they submitted but via fax and it was lost. A deadline came, and it was just sitting on a pile of papers.
We know it happens in varying degrees. Across states, this administrative burden is easier or harder. A lot of states have been trying to and successfully modernizing applications to have online applications.
What this study doesn’t address are patients who already have a cancer diagnosis and are already scheduled for surgery or undergoing chemo and might lose coverage. Therefore, they might not be able to receive chemo or have the surgery they planned for. So, not only are they under the stress of trying to beat cancer, they’re also under the stress of trying to navigate this complex system that’s kicked them off their health coverage.
Best case scenario, they lose coverage but re-verify the clerical error or get coverage through some other mechanism. But four, five, six months have gone by. That’s a window that can be lifesaving.
In this study, did you look downstream of missing screenings? What was the impact when measured in terms of being diagnosed with later stage cancer or death?
Ultimately, we report that about 155 avoidable deaths would occur based on missed screenings in this two-year period. For the three cancers we studied, it’s about 333 patients are diagnosed at what we would call advanced stage, stage 3 or 4. It might not sound like an exceedingly super large number. But this is 155 patients who otherwise should not have died of a potentially curable disease. That’s a really big deal. Each one of those 155 deaths is a mother, father, daughter.
We talk about all these lifesaving cancer therapies, some new drug that will save X number of lives. That’s incredible and amazing. We developed an innovation system that makes those possible. We also live in a country where we create this vacuum of access for patients who, forget about lifesaving immunotherapy, can’t even access something as simple as a mammogram. That just frustrates me incredibly.
STAT’s coverage of health inequities is supported by a grant from the Commonwealth Fund. Our financial supporters are not involved in any decisions about our journalism.
