Journal: Cancer
This article is a policy-focused commentary on how recent Medicaid financing reforms could adversely affect prostate cancer care, particularly active surveillance for favorable-risk disease.
Key points:
- The One Big Beautiful Bill Act (OBBBA), enacted in July 2025, substantially changes Medicaid financing with the stated goals of promoting patient independence and fiscal sustainability.
- The authors argue that these changes may destabilize continuity of care for cancer patients, with a large potential impact on prostate cancer given its high incidence in U.S. men.
- Active surveillance, an established and evidence-based management strategy for early-stage, favorable-risk prostate cancer, depends on reliable access to periodic PSA testing, imaging, and repeat biopsies.
- Even short insurance gaps or modest increases in out-of-pocket costs could disrupt this surveillance, leading to:
- Delayed detection of progression
- Overtreatment due to patients or clinicians abandoning surveillance
- More frequent late-stage presentations
- The article emphasizes that poorly designed financing reforms may:
- Worsen existing disparities in prostate cancer outcomes
- Increase long-term healthcare costs despite short-term savings
- Reverse improvements achieved over recent decades in managing low-risk prostate cancer conservatively.
- The authors call for recalibrating Medicaid reform to preserve access to guideline-concordant surveillance and protect vulnerable populations from avoidable harm.