TOPLINE:

Medicaid expansion was associated with improved 5‑year cause‑specific and overall survival among patients living in rural or high‑poverty communities and those diagnosed with pancreatic, lung, or colorectal cancer.

METHODOLOGY:

• Medicaid expansion in 2014 increased eligibility for lower-income adults, reduced uninsurance, improved access to cancer screening, and improved 2-year overall survival among patients newly diagnosed with cancer. However, data on longer-term cancer survival have been lacking.
• Researchers used a North American population‑based cancer registry data to identify over 1.4 million US adults (age, 18-59 years) who were diagnosed with cancer between 2007 and 2008 or 2014 and 2015. They resided in 26 states that expanded Medicaid in 2014 and 12 states that had not expanded eligibility as of 2020.
• The primary outcome was 5-year cause-specific cancer survival based on the Surveillance, Epidemiology, and End Results cause-specific death classification.
• Using a difference-in-differences (DD) approach, the researchers analyzed the association between Medicaid expansion and changes in survival, controlling for age, sex, race and ethnicity, county-level poverty rate, rurality, and state.

TAKEAWAY:

• During the 5‑year follow‑up period, cause‑specific survival rose from 77.7% to 79.5% in Medicaid expansion states and from 75.1% to 77.0% in nonexpansion states, resulting in a statistically nonsignificant net increase of 0.08 percentage points in expansion states.
• However, some groups within expansion states showed significant gains compared with their counterparts in nonexpansion states: Cause-specific survival improved to a greater degree in expansion states among individuals in rural areas (DD, 2.55 percentage points) and high-poverty communities (DD, 1.54 percentage points). Additionally, 5-year overall survival improved among these individuals (DD, 3.03 and 1.69 percentage points, respectively).
• Patients with certain cancers — colorectal, lung, and pancreatic — showed greater survival improvements if they lived in an expansion state. For pancreatic cancer, for example, 5-year cause-specific survival rose from 14.9% to 24.8% in expansion states compared to an increase from 16% to 22.8% in nonexpansion states (DD, 2.6 percentage points).
• Medicaid expansion was also associated with a greater increase in overall survival among non‑Hispanic Black individuals (DD, 1.05 percentage points), as well as gains in cause-specific and overall survival among non-Hispanic White individuals (DD, 0.37 and 0.57 percentage points, respectively).

IN PRACTICE:

These findings, the authors wrote, emphasize the need to protect current levels of Medicaid eligibility and “provide additional evidence and impetus for the importance of Medicaid expansion in the remaining 10 nonexpansion states, which are disproportionately represented by high poverty and rurality.” 

SOURCE:

The study, led by Elizabeth J. Schafer, MPH, Surveillance, Prevention, and Health Services Research, American Cancer Society, Atlanta, Georgia, was published online in Cancer Discovery.

LIMITATIONS:

Limitations include potential lead-time bias associated with generally expanded access to cancer prevention and detection services following the enactment of the Affordable Care Act. Additionally, the study excluded individuals with missing cause of death information and sociodemographic characteristics.

DISCLOSURES:

The study was funded by the American Cancer Society. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.