WASHINGTON, D.C. — In case you missed it, a new study published in JAMA Surgery found that Medicaid patients face significantly longer waits for critical cancer treatment than patients with private insurance. The findings offer another warning to policymakers considering government-controlled health care proposals that could further constrain provider access and worsen patient outcomes.

The study examined more than 2.7 million patients diagnosed with breast, colon, lung, pancreatic, gastric and esophageal cancers and found that public insurance status is an independent predictor of treatment delay, even after accounting for clinical, demographic and hospital characteristics.

The disparities are substantial. Medicaid patients with breast cancer were forced to wait an average of nearly six additional days for treatment and were approximately 42 percent more likely to experience waits exceeding 30 days compared to privately insured patients. For lung cancer, Medicaid patients waited roughly seven to eight additional days and were about 40 percent more likely to face prolonged delays. Similar patterns exist across colon, pancreatic and esophageal cancers. Across the cancers examined, privately insured patients generally experienced shorter wait times than patients covered by Medicare or Medicaid, while wait times for Medicaid were even worse than for uninsured patients.

For cancer patients, those delays can have serious consequences. According to the study, delayed surgical care has been linked with an approximately 20 percent to 30 percent increased risk of both 90-day and five-year mortality in lung cancer, and an approximately 10 percent to 15 percent greater likelihood in mortality in breast cancer. The findings underscore why timely access to treatment can be a matter of life and death.

Those delays can take a profound toll on a patients’ physical health, and on their mental health. The JAMA Surgery study states that treatment delays have been associated with patient anxiety, distress and potential adverse impacts on quality of life. The National Cancer Institute notes that chronic stress may cause cancer progression and metastasis, meaning prolonged treatment delays can compound the physical and emotional burden patients already face following a cancer diagnosis.

When delayed access to care can have such significant consequences for patients’ wellbeing, access to timely care must be prioritized. Yet the same government-controlled models that falsely promise lower costs can create their own barriers to care, particularly when lower reimbursement makes it harder to secure provider participation.

Research examining state public option plans has found that fewer physicians accept new Medicaid patients than privately insured patients and that Medicaid patients report longer wait times, particularly where reimbursement rates are lowest. That challenge stems from government reimbursement rates that principally fall short of the cost of delivering care. For example, according to the American Hospital Association, Medicare paid hospitals just 82 cents for every dollar spent caring for Medicare patients in 2022, while the Medicare Payment Advisory Committee found that hospitals’ fee-for-service Medicare margins had fallen to a record low. Findings from the Medicaid and CHIP Payment and Access Commission (MACPAC) further illustrate the extent of these reimbursement shortfalls; according to MACPAC, Medicaid base payment rates are often below hospital costs, forcing states to supplement those rates through billions of dollars’ worth of supplemental payments. Together, these reimbursement pressures can pose barriers to provider participation when government reimbursement rates fail to cover the costs of treating patients.

That trade-off between lowering costs and maintaining provider participation is central to the public option debate. State public option proposals have sought to lower premiums in part by tying provider payments to Medicare or Medicaid rates. However, this strategy is partly responsible for the absence of a successful public option in the United States. When government-set payments for care do not cover the cost of providing it, providers cannot absorb those losses indefinitely. As a result, lower reimbursement can make provider participation financially unsustainable, compounding existing challenges in areas like rural communities where provider shortages are already common.

The lesson for policymakers is straightforward: timely access to care matters for both outcomes and access, particularly when patients are facing life-threatening illnesses like cancer. When patients’ access to care is limited, as we have seen for cancer patients with Medicaid, there is often a direct correlation with adverse outcomes. As policymakers consider government-controlled health care proposals that rely on lower provider payments to generate savings, they would be wise to recognize the potential trade-offs for provider participation, patient choice and timely access to critical care.

Rather than doubling down on government-run models like the public option, which have failed everywhere they have been tested, policymakers should focus on building on what’s already working in our health care system and preserving patients’ access to care.

To read the full JAMA Surgery study, “National Trends and Predictors of Waiting Times for Cancer Surgery in the US,” CLICK HERE.

To read the Wall Street Journal article, “Dying for Medicare for All,” CLICK HERE.