A. N. Cobb1, E. Eguia1, U. Maduekwe2, C. Godellas1, P. C. Kuo3 1Loyola University Medical Center,General Surgery,Maywood, IL, USA 2Loyola University Medical Center,Plastic Surgery,Maywood, IL, USA 3University Of South Florida College Of Medicine,Tampa, FL, USA
Introduction:
Following the implementation of Medicaid expansion via the Affordable Care Act (ACA), more women had access to cancer surgical care. However, the rates of reconstruction following mastectomy remain low. This study aims to evaluate the impact of Medicaid expansion on the utilization of breast reconstruction following mastectomy for breast cancer.
Methods:
We conducted a retrospective review using the Healthcare Cost and Utilization Project (HCUP) State Inpatient Database (SID) for the years pre (2010-2013) and post (2014) Medicaid expansion. We compare the incidence of breast reconstruction in Medicaid expansion states (MD, NY, WA) vs. non-expansion (FL) states. Reconstruction was defined as the observed procedure rate per 1,000 cancer admissions. A generalized linear model with a Poisson distribution and logistic regression was used with incidence rate ratios (IRR) and difference-in-differences (DID).
Results:
We identified 65,178 females diagnosed with breast cancer. Of those 13,161 (16%), underwent breast reconstruction. Patients in non-expansion states were slightly older with a mean age of 49 (8.6) [vs 48 (8.6) p<.001] and had lower Elixhauser comorbidity indices at 2.0 (1.1) [vs. 2.1 (1.2) p<.0001]. Both groups were predominantly white (65%) and had Medicaid insurance, though there were a higher proportion of Medicaid patients in non-expansion states (86.1% vs. 84.5%). The rates of breast reconstruction did not significantly increase in expansion states, even when adjusting for age, comorbid disease and race (IRR=1.04 95% CI [.75,1.44]). Additionally, living in a Medicaid expansion state post-implementation did not increase patients’ odds of getting reconstructive surgery (OR 1.16 95% CI .82-1.65). African-American women were 30% (OR .68 95% CI .64-.72) less likely to get reconstruction than their white counterparts while Hispanic women had increased odds of reconstruction overall (OR 1.16 95% CI 1.08-1.24).
Conclusion:
The rates of breast reconstruction have remained virtually unchanged pre and post Medicaid Expansion in both expansion and non-expansion states. Disparities in breast reconstruction remain after the ACA's expansion of Medicaid and may disproportiontely impact African American women .