Projected losses in Medicaid coverage as a result of President Trump’s “One Big Beautiful Bill” could result in more than 1 million missed cancer screenings and hundreds of avoidable deaths within 2 years of federal Medicaid eligibility restrictions taking effect, researchers found.
Using a decision analytic model based on state-level Medicaid data for adult enrollees, 7.5 million Medicaid-enrolled adults eligible for cancer screening will lose coverage over the first 2 years of implementation of the restrictions, resulting in 1,152,664 missed breast, colorectal, and lung cancer screenings, reported Sarah P. Shubeck, MD, MS, and Adrian Diaz, MD, MPH, both of the University of Chicago.
Those missed screenings would translate to 2,341 undetected cancers — with an excess of 326 cancers presenting at an advanced stage — and 155 excess deaths, they projected in a research letter in JAMA Oncology.
“Overall, these findings highlight the substantial and preventable morbidity and mortality that could result from coverage retrenchment and underscores how national policy may result in divergent and costly public health consequences across states,” Shubeck and Diaz wrote.
The 2025 Budget Reconciliation Act, also known as the “One Big Beautiful Bill,” reduced federal Medicaid funding and included a number of significant Medicaid restrictions such as stricter work requirements and more frequent verification checks. The new requirements go into effect Jan. 1, 2027.
“These restrictions will disproportionately impact young and socially vulnerable enrollees, likely leading to coverage loss,” wrote Shubeck and Diaz. “Coupled with a shift toward younger patients (i.e., <65 years) being diagnosed with cancer, these changes could meaningfully reduce cancer screening and early detection. The magnitude of these effects remains uncertain.”
The model’s projections were based on three scenarios — a base scenario, as well as less and more restrictive scenarios. The base scenario represented a 12% work-requirement exit rate (based on the impact on enrollment when Arkansas enacted a work requirement for Medicaid expansion in 2018), as well as a 35% uplift in procedural churn based on estimates of routine month-to-month disenrollment from the Medicare Payment Advisory Commission.
The scenario involving less restrictive eligibility tightening would result in 819,689 missed screenings, 1,664 undetected cancers — with an excess of 232 cancers detected at an advanced stage — and 110 excess deaths.
A scenario involving more aggressive eligibility tightening would increase the number of missed screenings to 1,581,733, with 3,212 undetected cancers, an excess of 447 cancers detected at an advanced stage, and 213 excess deaths.
The estimated missed screenings and subsequent cancer outcomes varied substantially by state, the authors observed. Rates were generally lower in states without expanded Medicaid and those with small screening gaps between Medicaid-insured and uninsured adults, “largely driven by state-level safety-net programs that support uninsured cancer screening and treatment,” they said.
Shubeck and Diaz suggested that their estimates were on the conservative side. For example, they noted that their study focused on breast, colorectal, and lung cancer, indicating that “overall oncologic consequences are likely larger.” In addition, their estimates didn’t account for interruptions in ongoing cancer treatment.
“Broader impacts are possible for patients already undergoing cancer treatment, for whom delayed, interrupted, or missed treatment could further increase morbidity and mortality,” they wrote.
Story by Mike Bassett via MSN
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