Journal Article

Affordable Care Act Medicaid expansion and access to primary-care based smoking cessation assistance among cancer survivors: an observational cohort study

Angier, Heather, DeVoe, Jennifer E., Marino, Miguel, Bailey, Steffani R., Chung-Bridges, Katherine, Voss, Robert, Valenzuela, Steele H., Huguet, Nathalie

2022

Overview

Background Smoking among cancer survivors can increase the risk of cancer reoccurrence, reduce treatment effectiveness and decrease quality of life. Cancer survivors without health insurance have higher rates of smoking and decreased probability of quitting smoking than cancer survivors with health insurance. This study examines the associations of the Affordable Care Act (ACA) Medicaid insurance expansion with smoking cessation assistance and quitting smoking among cancer survivors seen in community health centers (CHCs). Methods Using electronic health record data from 337 primary care community health centers in 12 states that expanded Medicaid eligibility and 273 CHCs in 8 states that did not expand, we identified adult cancer survivors with a smoking status indicating current smoking within 6 months prior to ACA expansion in 2014 and ≥ 1 visit with smoking status assessed within 24-months post-expansion. Using an observational cohort propensity score weighted approach and logistic generalized estimating equation regression, we compared odds of quitting smoking, having a cessation medication ordered, and having ≥6 visits within the post-expansion period among cancer survivors in Medicaid expansion versus non-expansion states. Results Cancer survivors in expansion states had higher odds of having a smoking cessation medication order (adjusted odds ratio [aOR] = 2.54, 95%CI = 1.61-4.03) and higher odds of having ≥6 office visits than those in non-expansion states (aOR = 1.82, 95%CI = 1.22-2.73). Odds of quitting smoking did not differ significantly between patients in Medicaid expansion versus non-expansion states. Conclusions The increased odds of having a smoking cessation medication order among cancer survivors seen in Medicaid expansion states compared with those seen in non-expansion states provides evidence of the importance of health insurance coverage in accessing evidence-based tobacco treatment within CHCs. Continued research is needed to understand why, despite increased odds of having a cessation medication prescribed, odds of quitting smoking were not significantly higher among cancer survivors in Medicaid expansion states compared to non-expansion states.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adult / Adults / Affordable care act / Cancer / Cancer Survivors / Care and treatment / Cohort analysis / Cohort Studies / Community health centers / Comorbidity / Complications and side effects / Economic aspects / Electronic health records / Health Administration / Health aspects / Health Informatics / Health insurance / Health services / Health Services Accessibility / Hispanic people / Humans / Indigent care / Insurance Coverage / Laws, regulations and rules / Medicaid / Medical diagnosis / Medical fees / Medicine / Medicine & Public Health / Methods / Neoplasms - epidemiology / Neoplasms - therapy / Nursing Research / Observational studies / Patient Protection & Affordable Care Act 2010-US / Patient Protection and Affordable Care Act / Patients / Poverty / Primary care / Primary health care / Public Health / Quality of Life / Research Article / Services / Smoking / Smoking Cessation / Smoking cessation programs / Social aspects / Tobacco / Tobacco treatment / Uninsured people / United States - epidemiology