Medicaid Non-Expansion States Put More Women at Risk of Missing Recommended Cancer Screenings, Study in Women’s Health Issues Says

Media Contact: Kathy Fackelmann,, 202-994-8354

WASHINGTON, DC (February 23, 2016) — Uninsured low-income women already face financial barriers to receiving recommended screenings for breast and cervical cancer, and a greater number of these women will remain without health insurance—and at risk—in states that continue to balk at expanding Medicaid, according to a study published today in the journal Women’s Health Issues.

Women’s Health Issues is the official journal of the Jacobs Institute of Women’s Health, which is based at Milken Institute School of Public Health (Milken Institute SPH) at the George Washington University.

If the current non-expansion states do not change course by 2017, an estimated 23 percent of low-income women ages 21-64 in non-expansion states will remain uninsured, compared to eight percent of women in Medicaid expansion states, according to lead author Leighton Ku, PhD, MPH, Professor and Interim Chair of the Department of Health Policy and Management at Milken Institute SPH. That disproportionate number of poor, uninsured women in the non-expansion states will continue to have trouble accessing cancer screening tests, which can identify potentially life-threatening tumors at an earlier, and often more treatable, stage, Ku says.

With data from the Census Bureau’s American Community Survey and from Medicaid, Ku and his colleagues at Milken Institute SPH used a simulation model to estimate the proportion of women who would remain uninsured either with or without a Medicaid expansion. At the national level, the study examined two scenarios: (1) that only 29 states expand Medicaid (based on decisions as of June 2015) in 2017 and (2) that all states expand Medicaid by 2017. Under the first scenario, 18 percent of low-income US women ages 21-64 will remain uninsured – but if all states expand their Medicaid programs, that drops to 10 percent.
“Health reform has decreased the number of uninsured women, helping to assure greater access to breast and cervical cancer screening.  But Medicaid expansion decisions make a difference.  Even before the Affordable Care Act’s insurance expansions began, women in the states not expanding Medicaid were less likely to have had screening mammograms or Pap tests,” Ku says. “Widening disparities in insurance status will likely cause the pre-existing disparities in screening rates to widen even further, which will have consequences for the detection and treatment of breast and cervical cancer.”

The Centers for Disease Control and Prevention’s (CDC’s) National Breast and Cervical Cancer Early Detection Program (NBCCEDP) supports screening and diagnostic services for low-income uninsured or underinsured women, but currently lacks the funding to serve many of those who are eligible. The authors found that if the program’s current funding level continues to 2017, the NBCCEDP will only be able to serve between 12 and 38 percent of uninsured women if only 29 states expand Medicaid, or 17 to 54 percent if all states have put an expansion program in place. "Even if all states accept the Medicaid expansion, millions of low-income women will remain uninsured and will continue to need assistance from the CDC’s cancer screening programs," Ku points out.

Both Medicaid expansion and the CDC’s cancer screening programs remain crucial if low-income women are to access these tests in a timely way, he says. Breast and cervical cancer are among the leading causes of cancer death for women in the United States. However, screening tests can often catch these cancers before they have a chance to spread and turn deadly, Ku says.

The study, “Health Reform, Medicaid Expansions and Women’s Cancer Screening,” has been published online ahead of print and will appear in the journal’s May/June issue.


About Women’s Health Issues:
Women's Health Issues is the official publication of the Jacobs Institute of Women's Health, and the only journal devoted exclusively to women's health care and policy issues. The journal has a particular focus on women's issues in the context of the U.S. health care delivery system and policymaking processes, although it invites submissions addressing women's health care issues in global context if relevant to North American readers. It is a journal for health professionals, social scientists, policymakers, and others concerned with the complex and diverse facets of health care delivery and policy for women. For more information about the journal, please visit

About Milken Institute School of Public Health at the George Washington University:
Established in July 1997 as the School of Public Health and Health Services, Milken Institute School of Public Health is the only school of public health in the nation’s capital. Today, more than 1,700 students from almost every U.S. state and 39 countries pursue undergraduate, graduate and doctoral-level degrees in public health. The school also offers an online Master of Public Health, MPH@GW, and an online Executive Master of Health Administration, MHA@GW, which allow students to pursue their degree from anywhere in the world.