{"id":"https://openalex.org/W3031667052","doi":"https://doi.org/10.1200/jco.2020.38.15_suppl.2039","title":"Affordable Care Act Medicaid expansion does not reduce guideline concordant cancer care disparities in vulnerable populations.","display_name":"Affordable Care Act Medicaid expansion does not reduce guideline concordant cancer care disparities in vulnerable populations.","publication_year":2020,"publication_date":"2020-05-20","ids":{"openalex":"https://openalex.org/W3031667052","doi":"https://doi.org/10.1200/jco.2020.38.15_suppl.2039","mag":"3031667052"},"language":"en","primary_location":{"id":"doi:10.1200/jco.2020.38.15_suppl.2039","doi":"https://doi.org/10.1200/jco.2020.38.15_suppl.2039","is_oa":false,"landing_page_url":"https://doi.org/10.1200/jco.2020.38.15_suppl.2039","pdf_url":null,"source":{"id":"https://openalex.org/S15137598","display_name":"Journal of Clinical Oncology","issn_l":"0732-183X","issn":["0732-183X","1527-7755"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-scientific","cwts-core","dongbi-a","doyens","jufo-3","ki-jl-3","medline","norway-2","poland-200","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310315671","host_organization_name":"Lippincott Williams & Wilkins","host_organization_lineage":["https://openalex.org/P4310315671","https://openalex.org/P4310318547"],"host_organization_lineage_names":["Lippincott Williams & Wilkins","Wolters Kluwer"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Clinical Oncology","raw_type":"journal-article"},"volume":null,"type":"conference-abstract","indexed_in":["crossref"],"open_access":{"is_oa":false,"oa_status":"closed","oa_url":null,"any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5005655365","display_name":"Michelle R. Ju","orcid":"https://orcid.org/0000-0003-0920-7617","observed_orcids":["https://orcid.org/0000-0003-0920-7617"]},"institutions":[{"id":"https://openalex.org/I867280407","display_name":"The University of Texas Southwestern Medical Center","ror":"https://ror.org/05byvp690","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I867280407"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Michelle Ju","raw_affiliation_strings":["UT Southwestern, Dallas, TX;"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"UT Southwestern, Dallas, TX;","institution_ids":["https://openalex.org/I867280407"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5002060929","display_name":"James-Michael Blackwell","orcid":"https://orcid.org/0000-0002-9137-3878","observed_orcids":["https://orcid.org/0000-0002-9137-3878"]},"institutions":[{"id":"https://openalex.org/I867280407","display_name":"The University of Texas Southwestern Medical Center","ror":"https://ror.org/05byvp690","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I867280407"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"James-Michael Blackwell","raw_affiliation_strings":["UT Southwestern, Dallas, TX;"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"UT Southwestern, Dallas, TX;","institution_ids":["https://openalex.org/I867280407"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5034674540","display_name":"Patricio Marcelo Polanco","orcid":"https://orcid.org/0000-0002-1719-1208","observed_orcids":["https://orcid.org/0000-0002-1719-1208"]},"institutions":[{"id":"https://openalex.org/I867280407","display_name":"The University of Texas Southwestern Medical Center","ror":"https://ror.org/05byvp690","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I867280407"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Patricio Polanco","raw_affiliation_strings":["Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX;"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX;","institution_ids":["https://openalex.org/I867280407"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5053019255","display_name":"John C. Mansour","orcid":"https://orcid.org/0000-0001-6346-9429","observed_orcids":["https://orcid.org/0000-0001-6346-9429"]},"institutions":[{"id":"https://openalex.org/I867280407","display_name":"The University of Texas Southwestern Medical Center","ror":"https://ror.org/05byvp690","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I867280407"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"John C. Mansour","raw_affiliation_strings":["Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX;"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX;","institution_ids":["https://openalex.org/I867280407"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5040090483","display_name":"Sam C. Wang","orcid":"https://orcid.org/0000-0003-3626-5273","observed_orcids":["https://orcid.org/0000-0003-3626-5273"]},"institutions":[{"id":"https://openalex.org/I867280407","display_name":"The University of Texas Southwestern Medical Center","ror":"https://ror.org/05byvp690","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I867280407"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Sam C. Wang","raw_affiliation_strings":["Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX;"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX;","institution_ids":["https://openalex.org/I867280407"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5031442486","display_name":"Matthew R. Porembka","orcid":"https://orcid.org/0000-0003-1596-0058","observed_orcids":["https://orcid.org/0000-0003-1596-0058"]},"institutions":[{"id":"https://openalex.org/I867280407","display_name":"The University of Texas Southwestern Medical Center","ror":"https://ror.org/05byvp690","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I867280407"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Matthew R. Porembka","raw_affiliation_strings":["Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX;"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX;","institution_ids":["https://openalex.org/I867280407"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5073859061","display_name":"Herbert J. Zeh","orcid":"https://orcid.org/0000-0003-2017-1934","observed_orcids":["https://orcid.org/0000-0003-2017-1934"]},"institutions":[{"id":"https://openalex.org/I867280407","display_name":"The University of Texas Southwestern Medical Center","ror":"https://ror.org/05byvp690","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I867280407"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Herbert Zeh","raw_affiliation_strings":["Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX;"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX;","institution_ids":["https://openalex.org/I867280407"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5085283718","display_name":"Adam Charles Yopp","orcid":"https://orcid.org/0000-0002-5887-5315","observed_orcids":["https://orcid.org/0000-0002-5887-5315"]},"institutions":[{"id":"https://openalex.org/I867280407","display_name":"The University of Texas Southwestern Medical Center","ror":"https://ror.org/05byvp690","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I867280407"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Adam Charles Yopp","raw_affiliation_strings":["Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX;"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX;","institution_ids":["https://openalex.org/I867280407"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":1,"corresponding_author_ids":[],"corresponding_institution_ids":["https://openalex.org/I867280407"],"apc_list":null,"apc_paid":null,"fwci":null,"has_fulltext":false,"cited_by_count":0,"citation_normalized_percentile":null,"cited_by_percentile_year":null,"biblio":{"volume":"38","issue":"15_suppl","first_page":"2039","last_page":"2039"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10391","display_name":"Healthcare Policy and Management","score":0.7060999870300293,"subfield":{"id":"https://openalex.org/subfields/2002","display_name":"Economics and Econometrics"},"field":{"id":"https://openalex.org/fields/20","display_name":"Economics, Econometrics and Finance"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},"topics":[{"id":"https://openalex.org/T10391","display_name":"Healthcare Policy and Management","score":0.7060999870300293,"subfield":{"id":"https://openalex.org/subfields/2002","display_name":"Economics and Econometrics"},"field":{"id":"https://openalex.org/fields/20","display_name":"Economics, Econometrics and Finance"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},{"id":"https://openalex.org/T10556","display_name":"Global Cancer Incidence and Screening","score":0.12309999763965607,"subfield":{"id":"https://openalex.org/subfields/2730","display_name":"Oncology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10235","display_name":"Health disparities and outcomes","score":0.10080000013113022,"subfield":{"id":"https://openalex.org/subfields/3306","display_name":"Health"},"field":{"id":"https://openalex.org/fields/33","display_name":"Social Sciences"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/affordable-care-act","display_name":"Affordable Care Act","score":0.8360000252723694},{"id":"https://openalex.org/keywords/medicaid-expansion","display_name":"Medicaid expansion","score":1.0},{"id":"https://openalex.org/keywords/cancer-care-disparities","display_name":"cancer care disparities","score":0.8240000009536743},{"id":"https://openalex.org/keywords/racial-and-ethnic-disparities","display_name":"racial and ethnic disparities","score":0.878000020980835},{"id":"https://openalex.org/keywords/guideline-concordant-care","display_name":"guideline-concordant care","score":0.8629999756813049},{"id":"https://openalex.org/keywords/health-insurance-coverage","display_name":"health insurance coverage","score":0.5830000042915344},{"id":"https://openalex.org/keywords/hispanic-patients","display_name":"Hispanic patients","score":0.7120000123977661},{"id":"https://openalex.org/keywords/black-patients","display_name":"Black patients","score":0.7360000014305115},{"id":"https://openalex.org/keywords/socioeconomic-status","display_name":"socioeconomic status","score":0.8080000281333923},{"id":"https://openalex.org/keywords/access-to-cancer-care","display_name":"access to cancer care","score":0.546999990940094},{"id":"https://openalex.org/keywords/health-equity","display_name":"health equity","score":0.656000018119812}],"concepts":[{"id":"https://openalex.org/C2776534028","wikidata":"https://www.wikidata.org/wiki/Q1141363","display_name":"Medicaid","level":3,"score":0.9020237922668457},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.8614936470985413},{"id":"https://openalex.org/C2780182762","wikidata":"https://www.wikidata.org/wiki/Q1630279","display_name":"Guideline","level":2,"score":0.6258783340454102},{"id":"https://openalex.org/C147077947","wikidata":"https://www.wikidata.org/wiki/Q1515895","display_name":"Socioeconomic status","level":3,"score":0.6153201460838318},{"id":"https://openalex.org/C2778979077","wikidata":"https://www.wikidata.org/wiki/Q330190","display_name":"Receipt","level":2,"score":0.5576671957969666},{"id":"https://openalex.org/C149923435","wikidata":"https://www.wikidata.org/wiki/Q37732","display_name":"Demography","level":1,"score":0.5220196843147278},{"id":"https://openalex.org/C137403100","wikidata":"https://www.wikidata.org/wiki/Q41710","display_name":"Ethnic group","level":2,"score":0.48303207755088806},{"id":"https://openalex.org/C512399662","wikidata":"https://www.wikidata.org/wiki/Q3505712","display_name":"Family medicine","level":1,"score":0.47218313813209534},{"id":"https://openalex.org/C121608353","wikidata":"https://www.wikidata.org/wiki/Q12078","display_name":"Cancer","level":2,"score":0.4264524579048157},{"id":"https://openalex.org/C160735492","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Health care","level":2,"score":0.4257630705833435},{"id":"https://openalex.org/C74909509","wikidata":"https://www.wikidata.org/wiki/Q10387","display_name":"Gerontology","level":1,"score":0.382547527551651},{"id":"https://openalex.org/C2908647359","wikidata":"https://www.wikidata.org/wiki/Q2625603","display_name":"Population","level":2,"score":0.3248506784439087},{"id":"https://openalex.org/C99454951","wikidata":"https://www.wikidata.org/wiki/Q932068","display_name":"Environmental health","level":1,"score":0.2601729929447174},{"id":"https://openalex.org/C126322002","wikidata":"https://www.wikidata.org/wiki/Q11180","display_name":"Internal medicine","level":1,"score":0.12277299165725708},{"id":"https://openalex.org/C50522688","wikidata":"https://www.wikidata.org/wiki/Q189833","display_name":"Economic growth","level":1,"score":0.0},{"id":"https://openalex.org/C41008148","wikidata":"https://www.wikidata.org/wiki/Q21198","display_name":"Computer science","level":0,"score":0.0},{"id":"https://openalex.org/C136764020","wikidata":"https://www.wikidata.org/wiki/Q466","display_name":"World Wide Web","level":1,"score":0.0},{"id":"https://openalex.org/C19165224","wikidata":"https://www.wikidata.org/wiki/Q23404","display_name":"Anthropology","level":1,"score":0.0},{"id":"https://openalex.org/C142724271","wikidata":"https://www.wikidata.org/wiki/Q7208","display_name":"Pathology","level":1,"score":0.0},{"id":"https://openalex.org/C144024400","wikidata":"https://www.wikidata.org/wiki/Q21201","display_name":"Sociology","level":0,"score":0.0},{"id":"https://openalex.org/C162324750","wikidata":"https://www.wikidata.org/wiki/Q8134","display_name":"Economics","level":0,"score":0.0}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.1200/jco.2020.38.15_suppl.2039","doi":"https://doi.org/10.1200/jco.2020.38.15_suppl.2039","is_oa":false,"landing_page_url":"https://doi.org/10.1200/jco.2020.38.15_suppl.2039","pdf_url":null,"source":{"id":"https://openalex.org/S15137598","display_name":"Journal of Clinical Oncology","issn_l":"0732-183X","issn":["0732-183X","1527-7755"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-scientific","cwts-core","dongbi-a","doyens","jufo-3","ki-jl-3","medline","norway-2","poland-200","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310315671","host_organization_name":"Lippincott Williams & Wilkins","host_organization_lineage":["https://openalex.org/P4310315671","https://openalex.org/P4310318547"],"host_organization_lineage_names":["Lippincott Williams & Wilkins","Wolters Kluwer"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Clinical Oncology","raw_type":"journal-article"}],"best_oa_location":null,"sustainable_development_goals":[{"score":1.0,"id":"https://metadata.un.org/sdg/3","display_name":"Good health and well-being"},{"score":1.0,"id":"https://metadata.un.org/sdg/10","display_name":"Reduced inequalities"},{"score":0.47620001435279846,"id":"https://metadata.un.org/sdg/16","display_name":"Peace, justice, and strong institutions"}],"study_designs":[],"awards":[],"funders":[],"has_content":{"grobid_xml":false,"pdf":false},"content_urls":null,"referenced_works_count":0,"referenced_works":[],"related_works":["https://openalex.org/W2948577422","https://openalex.org/W3184693506","https://openalex.org/W2966729589","https://openalex.org/W2947407808","https://openalex.org/W2996839225","https://openalex.org/W2947729318","https://openalex.org/W3096995011","https://openalex.org/W3016020979","https://openalex.org/W4379341386","https://openalex.org/W4400972701"],"abstract_inverted_index":{"2039":[0],"Background:":[1],"The":[2,21],"receipt":[3,58,140,209,253],"of":[4,28,50,59,72,77,101,111,136,184,200,208,210,254,280,292],"timely,":[5],"guideline":[6,61,137,211,232,255,281,294],"concordant":[7,62,117,138,212,233,256,282,295],"cancer":[8,34,63,78,257,309],"amongst":[9],"racial/ethnic":[10,54],"and":[11,44,83,103,151,242,312],"socioeconomic":[12],"vulnerable":[13],"populations":[14],"remains":[15],"a":[16],"significant":[17],"health":[18],"policy":[19],"issue.":[20],"Affordable":[22],"Care":[23],"Act":[24],"(ACA)":[25],"with":[26,74,130,141,263],"implementation":[27],"Medicaid":[29,51,95,105,145,176,261,273],"Expansion":[30],"sought":[31],"to":[32,94,196,230,304,308],"reduce":[33],"disparities":[35,55,251,287],"by":[36,215],"reducing":[37],"uninsured":[38],"rates,":[39],"theoretically":[40],"improving":[41,318],"healthcare":[42],"access":[43],"delivery.":[45],"We":[46,66,125,156],"assessed":[47],"the":[48,57,86,171,179,206,271,278,290],"impact":[49],"expansion":[52,96,106,177,198,262,274],"on":[53,99,122,134],"in":[56,85,113,170,182,252,289],"timely":[60],"care.":[64],"Methods:":[65],"identified":[67,157],"patients":[68],"between":[69,219],"40-64":[70],"years":[71],"age":[73,166],"all":[75,188],"stages":[76],"(lung,":[79],"colorectal,":[80],"breast,":[81],"uterine,":[82],"cervical)":[84],"National":[87],"Cancer":[88],"Database,":[89],"2012-2015.":[90,220],"Patients":[91,169],"were":[92,226],"assigned":[93],"cohort":[97],"based":[98,121],"state":[100],"residence":[102],"whether":[104],"was":[107,119],"enacted":[108],"at":[109,317],"date":[110],"diagnosis":[112],"that":[114],"state.":[115],"Guideline":[116],"care":[118,139,213,234,258,283,310],"defined":[120],"NCCN":[123],"guidelines.":[124],"constructed":[126],"an":[127],"ecological":[128,204],"model":[129],"multivariate":[131],"regression":[132],"analysis":[133],"rate":[135,207,279],"covariates":[142],"including":[143],"race/ethnicity,":[144],"expansion,":[146],"SES,":[147],"gender,":[148],"Charlson-Deyo":[149],"score,":[150],"treatment":[152],"facility":[153],"type.":[154],"Results:":[155],"445,952":[158],"patients,":[159],"12%":[160],"Black,":[161],"6%":[162],"Hispanic":[163],"white,":[164],"median":[165],"55":[167],"years.":[168],"lowest":[172],"SES":[173,189],"quartile":[174],"following":[175],"had":[178,191],"greatest":[180],"increase":[181],"rates":[183,194],"insured":[185,193],"status,":[186],"although":[187],"quartiles":[190],"increased":[192],"compared":[195],"non-Medicaid":[197],"regardless":[199],"race/ethnicity.":[201],"In":[202],"our":[203],"model,":[205],"declined":[214],"0.5%":[216],"per":[217],"year":[218],"After":[221],"adjusting":[222],"for":[223],"covariates,":[224],"Asians":[225],"2.8%":[227],"less":[228,240,245],"likely":[229,246],"receive":[231],"than":[235],"non-Hispanic":[236],"whites,":[237],"Blacks":[238],"3.8%":[239],"likely,":[241],"Hispanics":[243],"6.3%":[244],"(p":[247],"<":[248],"0.0001).":[249],"Racial/ethnic":[250],"remained":[259],"after":[260],"no":[264],"differential":[265],"benefit.":[266],"Conclusions:":[267],"Insurance":[268],"gains":[269],"under":[270],"ACA":[272],"did":[275],"not":[276],"affect":[277],"receipt.":[284],"Significant":[285],"racial":[286],"persist":[288],"likelihood":[291],"receiving":[293],"care,":[296],"particularly":[297],"among":[298],"Hispanics.":[299],"Further":[300],"studies":[301],"are":[302],"needed":[303],"determine":[305],"additional":[306],"barriers":[307],"access/delivery":[311],"identify":[313],"key":[314],"targets":[315],"aimed":[316],"equity.":[319]},"counts_by_year":[],"updated_date":"2026-09-22T06:50:58.402377","created_date":"2020-06-05T00:00:00"}
