Although the measure of improved health care through three years of Obamacare has largely focused on the growing number of the insured, especially among low-income and disabled Medicaid patients, the true measure is health outcomes.

Those numbers are not as encouraging. A new study (pdf) from the University of California, Davis’ Institute for Population Health Improvement found that cancer patients covered by Medi-Cal, the state’s version of Medicaid, died more often and weren’t as likely to receive recommended treatment.

“These patients were diagnosed at more advanced stages of disease, received lower quality of care and had poorer outcomes than persons having private insurance or insurance coverage through Medicare, VA or DoD,” institute Director Dr. Kenneth Kizer said.

Their health results were similar to people without insurance. “If we weren't spending billions of Medi-Cal dollars on cancer care perhaps that would not be surprising, but you'd think that the outcomes might be better when you're spending that much money,” Dr. Kizer told Kaiser Health News. Cancer is the second-leading cause of death in the state and nation.

The researchers used data from the California Cancer Registry to track 700,000 residents diagnosed with lung, prostate, breast, colon, and rectal cancer between 2004 and 2012. They compared Medi-Cal outcomes to Medicare, dual Medi-Cal/Medicare, private insurance, Department of Defense (DOD) insurance and Department of Veterans Affairs (VA) insurance.

Medi-Cal patients were diagnosed with advanced (stage IV) prostate cancer three times more often than those with DOD or private insurance. The poorest of patients, those receiving a combination of Medi-Cal and Medicare coverage, were least likely to receive recommended treatment for breast or colon cancer.

Medi-Cal patients were likely to have breast cancer diagnosed at an early stage 39% of the time, compared to DOD (62.3%), private insurance (61.4%) and Medicare (60.4%).

Medicare and Medicare-Medi-Cal dual-eligible patients received the recommended radiotherapy for positive regional lymph nodes following mastectomy 49.6% and 46.8% of the time, respectively. The rate for VA patients was 93.8%.

Medi-Cal and uninsured patients were likely to have late-stage colon cancer 31.9% and 28.7% of the time, respectively. VA patients checked in at 14.7%. Medi-Cal patients were twice as likely to have late-stage rectal cancer, 30.9% to 14.4%, than privately insured patients.

VA patients generally had the longest waits, but their outcomes compared favorably to other types of insurance.

Medi-Cal is California’s largest insurance program. Enrollment has increased from 7 to over 12 million members over the past three years while costs have doubled to more than $6 billion.

–Ken Broder

To Learn More:

Cancer Patients with Medi-Cal More Likely to Die (by Barbara Feder Ostrov, Kaiser Health News)

Statewide Cancer Report Finds Significant Disparities in Outcomes, Quality of Care by Insurer (UC Davis Health System)

Disparities in Stage at Diagnosis, Survival, and Quality of Cancer Care in California by Source of Health Insurance (by Arti Parikh-Patel, Cyllene R. Morris, Kenneth W. Kizer and Robert P. Martinsen, UC Davis’ Institute for Population Health Improvement) (pdf)