U.S. – Women with breast cancer living in states that expanded Medicaid eligibility were less likely to die from the disease — but not everyone benefited equally, according to a recent study published in the medical journal JAMA Network Open.

Researchers from Howard University, the University of Alabama, Henry Ford Hospital in Michigan, and others looked at data from about 1.6 million women ages 40 to 64 who were diagnosed with breast cancer between 2006 and 2021.

They compared survival rates among women living in states that expanded Medicaid eligibility under the Affordable Care Act, commonly known as Obamacare, with the rates in states that did not expand. About 58% of the women lived in expansion states, and roughly 42% lived in nonexpansion states. States began expanding Medicaid in 2014.

The researchers found that Medicaid expansion was associated with lower overall mortality — no matter the disease stage, race or ethnicity, or neighborhood income of the women. Women in expansion states whose cancer had spread to other organs — the most advanced stage of disease — saw the most significant decline in deaths.

Among racial and ethnic groups, the largest relative gains were among Hispanic women — they were 19% less likely to die if they lived in an expansion state. There were smaller gains among non-Hispanic Black women and residents of low-income areas. The smallest difference was among white women.

Hispanic women’s large gains could be due to many previously lacking insurance, said Dr. Oluwasegun Akinyemi, director of Howard University College of Medicine’s Clive O. Callender Outcomes Research Center and a coauthor of the study.

Black women have higher breast cancer death rates compared to white women, even though there are fewer cases among them, partly because they are often diagnosed with the disease at a later stage.

Overall, Black women with breast cancer benefitted less from Medicaid expansion than other groups because they are disproportionately located in the South, where most states have not expanded, Akinyemi noted. The expansion holdout states include Alabama, Florida, Georgia, Mississippi, South Carolina, Tennessee and Texas.

The remaining three nonexpansion states are Kansas, Wisconsin and Wyoming.

The researchers also compared mortality rates in low- and high-income neighborhoods. Women living in the highest-income neighborhoods, as well as those who received immunotherapy treatment, had lower mortality rates. Akinyemi said that result suggests that coverage leads to greater access to treatment.

In July, President Donald Trump signed a broad tax and spending bill  that will cut federal Medicaid funding by more than $900 billion over the next decade. As a result, about 15 million people may lose Medicaid coverage, according to estimates by the Center on Budget and Policy Priorities.

Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org.

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