Is Medicaid Expansion Under the ACA Linked to Better Survival After Surgery for NSCLC?

By: Chris Schimpf, BS
Posted: Monday, February 12, 2024

The findings of a recent U.S. hospital–based study published in JAMA Network Open suggest that Medicaid expansion may be an effective strategy for improving access to care and cancer outcomes among patients with non–small cell lung cancer (NSCLC) who undergo lung surgery. Leticia M. Nogueira, PhD, MPH, of the American Cancer Society, Atlanta, and colleagues reported that within the studied cohort, Medicaid expansion under the Affordable Care Act (ACA) was associated with a significant reduction in 30- and 90-day mortality rates after surgical resection of stage I to III NSCLC.

“Lung cancer is the second most commonly diagnosed cancer in the U.S. and the leading cause of cancer-related mortality, but Medicaid expansion can help improve access to lifesaving care,” said Dr. Nogueira in an American Cancer Society press release. “Especially after a major procedure like lung cancer surgery, it’s crucial that people have access to timely care. As policymakers consider whether to expand or update Medicaid, our study details how coverage leads to positive health outcomes.”

A total of 14,984 adults (aged 45–64) who underwent surgical resection of NSCLC between 2008 and 2019 were included in the cohort study, drawn from the National Cancer Database. The investigators compared Medicaid expansion status of patients’ states of residence, and then they used difference-in-differences analyses to evaluate the association between Medicaid expansion and postoperative mortality before ACA implementation (2008–2013) vs after (2014–2019).

The mean age of participants was 56.3, 54.6% were women, and 62.1% lived in Medicaid expansion states. In those states, the researchers reported that the postoperative 30-day mortality rate went from 1.0% to 0.3% and the 90-day mortality rate went from 2.6% to 1.3% (both P < .001) after ACA implementation. In the states without Medicaid expansion, the 30-day mortality rate was 0.8% before ACA implementation vs 0.7% after (P = .74), and the 90-day mortality rate was 2.4% before ACA implementation vs 2.2% after (P = .57).

Disclosure: For full disclosures of the study authors, visit jamanetwork.com.

JAMA Network Open