Hello, my name is Jonathan Wesley Borden. I'm pleased to share my team's findings about how Medicaid expansion is associated with increased administration of standard of care therapy and lower uninsured rates in glioblastoma patients. I acknowledge and thank my funding sources, the Simmons Center for Cancer Research and the Brigham Young University Department of Neuroscience, as well as each of my co-authors and mentors for their help with this project. The Patient Protection and Affordable Care Act changed healthcare policy in the United States, including by allowing low-income adults to become eligible for Medicaid in some states. Glioblastoma is one of the most dangerous and common types of brain cancer and has a median survival of less than two years. Our study was developed to explore how state-level adoption of the Affordable Care Act impacted patient care, as well as insurance coverage. We anticipate that an understanding of how these healthcare policies have been associated with changes in care for patients can assist in future decisions about healthcare policy. We used a cohort of about 70,000 glioblastoma patients diagnosed between 2007 and 2015 across the United States from the National Cancer Database. We analyzed the relationships between the Affordable Care Act and our outcome variables, which were standard of care therapy, healthcare insurance coverage, and temporal patterns of care. Many factors have played a part in the gradual increase in receipt of standard of care therapy over time that is shown here in Panel A. As explained, one of the potential factors was Medicaid expansion, which was implemented near the beginning of 2014. We found that it was associated with a statistically significant increase in proportion of patients receiving standard of care therapy in expansion states, but not in non-expansion states. Panel B shows that in expansion states, the increase in proportion of patients receiving standard of care therapy was significant between 2007 to 2009 and 2010 to 2013, as well as between 2010 to 2013 and 2014 to 2015. However, Panel C shows that in non-expansion states, the increase was only significant between 2007 to 2009 and 2010 to 2013, and the change was not significant at the time that Medicaid expansion was implemented between 2010 to 2013 and 2014 to 2015. This difference in change between expansion and non-expansion states suggests that Medicaid expansion did play a part in increasing the rate of standard of care therapy for GBM patients. A difference in differences test confirms this, and is shown to the right of the panel figures. According to transitional data during 2013 to 2014, the difference in differences was 2.6%. Though the increase in standard of care for GBM patients over this time frame was due to many factors, such as an improvement over time by doctors to treat patients, this evidence shows that Medicaid expansion with the Affordable Care Act was a participating factor in that increase. Medicaid expansion was also associated with a decrease in uninsured rate. The uninsured rate for new glioblastoma patients in 2013 was 4.2% and 3.0% in 2014. Medicaid expansion was not associated with any changes in time to first treatment for our cohort, but it was loosely associated with an increase in time from first treatment to adjuvant therapy. We anticipate that this change has more to do with other factors that changed over time besides the expansion of Medicaid. Thank you for participating virtually in this presentation.

Jonathan Wesley Borden

Medicaid expansion

glioblastoma

patient care

insurance coverage