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Abstract
Highlights
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- Medicaid expansion opt-out may decrease access to care for low income uninsured and under-insured gynecologic oncology patients in Central Virginia
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- Minority women and women with cancer will be disproportionately affected
Objective
Many
gynecologic oncology (GO) patients in Virginia are low income and their
care is supplemented by Disproportionate Share Hospital (DSH) funds.
Our objective is to estimate how many new GO patients may lose access to
care if the state forgoes Medicaid expansion.
Methods
New
patients referred to the GO service between July 1st, 2010 and July
1st, 2012 were identified. Data were collected regarding age, race,
referral diagnosis, payor, and state pay scale. Pay scale 1 (PS1) is
equal to the federal poverty level (FPL). Assumptions included: (1) pay
scale is a surrogate for income, (2) PS 1 patients will be ineligible
for discounted insurance through the exchanges, and (3) decreasing DSH
funds will result in a reduction of the free-care pool.
Results
There
were 1623 referrals to the GO service and the majority (83%) was
Caucasian. The payor distribution was 44% commercial insurance, 5.6%
Medicaid, 31% Medicare, and 10.4% uninsured. Among the 361 women who
were PS1, 32% were uninsured. Thirty percent of PS1 patients were
minorities and 47.4% had a malignancy. Of note, 52% of new patients with
cervical cancer were PS1.
Conclusion
Seven
percent of new GO patients are PS 1 and uninsured. This population
contains a disproportionate number of minorities and women with cancer.
These women will have difficulty affording care as DSH funding
decreases, particularly in states with lean Medicaid that opt out of
Medicaid expansion. The burden of lack of access to care will be
shouldered by an unfortunate few.
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- This paper was presented as an oral presentation at the SGO Annual Meeting, Los Angeles, CA, March 2013.
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