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North Carolina is missing an opportunity for improved cancer care
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North Carolina is missing an opportunity for improved cancer care

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Medicaid funding is a key tool in the fight against cancer, especially for uninsured and underinsured populations. The goal is to make sure that all who need it will benefit from it. For patients in North Carolina, a cancer diagnosis can be especially frightening. A recent study showed that cancer patients in ‘holdout’ states like ours experienced lower survival rates — including a 31% increase in mortality risk among breast cancer patients.

The outlook improves the sooner one can be screened, diagnosed and treated. Yet for too many in our state, including those with cancer, access to timely, high-quality health care is out of reach because of financial issues. Some have lost their jobs or had their hours reduced due to the COVID-19 pandemic, resulting in loss of employer-sponsored insurance or other economic hardships.

Screening for early detection of breast and colon cancer as well as skin-related malignancies and cervical cancer has been adversely affected by the pandemic. This has significantly affected the underinsured populations in North Carolina. The American College of Surgeons Commission on Cancer along with a major partner, the American Cancer Society, has launched a special study in June 2021 to quantify this negative effect on screening due to COVID-19.

In addition to screening, Medicaid has long helped North Carolina families access the care they need. But there is currently a gap between people who earn too much to qualify for Medicaid and those who make too little to qualify for a subsidy in the health insurance marketplace.

Thus far, 38 states have moved to close that Medicaid gap, with the federal government paying 90 percent of the cost. If North Carolina’s legislature followed suit, more than 600,000 residents would gain health insurance and access to proper care, according to the Kaiser Family Foundation. They include service workers, small business owners, child-care providers, military veterans and parents of young children.

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Low income adults in states that haven’t closed that gap are four times more likely to be uninsured, according to the American Cancer Society. Having health insurance is one of the strongest positive indicators for cancer survival.

Research has found a high percentage of low income families, Black and rural residents have no health insurance, which increases their risk for late-stage cancer when treatment is more expensive and chances for survival significantly decrease.

There is also strong evidence that racial discrimination can limit access to health care. Black citizens have the highest death rate and the lowest survival rate of any racial or ethnic group for most cancers, according to the American Cancer Society. The disease cuts a broad swath across the country: An estimated 2.3 million Americans with a history of cancer rely on Medicaid coverage for screenings, diagnostic tests, treatments, surgical procedures, prescription medicines and follow-up care.

A poll last year by Care4Carolina, a coalition representing 110 organizations supporting affordable, quality health care, found strong bipartisan support across the state and political spectrum.

This year alone, nearly 64,000 North Carolinians will be diagnosed with cancer and an estimated 20,000 will die from the disease, making it the leading cause of death in North Carolina.

The message is that all of us in North Carolina are missing an opportunity for improved cancer care as we continue to debate Medicaid expansion. The benefits go beyond cancer care. Medicaid expansion would benefit citizens with other acute and chronic diseases. Time for debate is over; data support that inactivity on this legislation is an ongoing health care hazard.

Frederick L. Greene, MD, FACS, is the medical director of the Cancer Data Registry at the Levine Cancer Institute, Charlotte.


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