The Affordable Care Act’s Medicaid expansion program was associated with a decrease in disparities among patients with non-small cell lung cancer (NSCLC), according to research presented at the American Association for Thoracic Surgery (AATS) Annual Meeting.
Researchers found that Medicaid expansion was associated with increased insurance enrollment among NSCLC patients, earlier diagnosis of NSCLC, and improved access to NSCLC treatment at academic institutions.
The researchers analyzed data from the National Cancer Database that included adults 40 to 64 years of age who were diagnosed with NSCLC between 2009 and 2019. Diagnoses in 2014 were excluded, as that was the year that Medicaid expansion began.
Patients were divided into the pre-Medicaid expansion era (2009-2013) and the post-Medicaid expansion era (2015-2019). The groups were also studied in relation to their state of residence and whether that state expanded Medicaid coverage in 2014.
A total of 202,003 patients were included — 97,792 patients in the pre-expansion era and 104,211 in the post-expansion era. In the overall cohort, the median age was 58 years, 53.0% of patients were men, and 79.7% were White.
Among patients who lived in states with Medicaid expansion, insurance coverage increased from 90.1% pre-expansion to 96.7% post-expansion (P <.01). Among patients who lived in states without Medicaid expansion, insurance coverage increased from 84% to 88.3% (P <.01). Insurance enrollment increased at a faster rate across all demographic groups in Medicaid expansion states.
Among patients who lived in states with Medicaid expansion, diagnosis of stage I NSCLC increased from 18.8% pre-expansion to 25.3% post-expansion (P <.01). Among patients who lived in states without Medicaid expansion, diagnosis of stage I NSCLC increased from 17.6% to 21.6% (P <.01).
Among patients who lived in states with Medicaid expansion, treatment at an academic center increased from 40.4% pre-expansion to 43.9% post-expansion (P <.01). Among patients who lived in states without Medicaid expansion, treatment at an academic center increased from 28.4% to 28.6% (P =.45). The likelihood of treatment at an academic facility increased across all demographic groups only in Medicaid expansion states.
Superior overall survival was observed in Medicaid expansion states in the pre- and post-expansion eras, but the trend seemed to be heightened after expansion, according to the researchers.
Salami A, Martin J, Joshi S, et al. Impact of Medicaid expansion under the Patient Protection and Affordable Care Act on lung cancer care in the US. AATS 2023. May 6-9, 2023. Abstract 18.