In a new national hospital-based study, researchers from the American Cancer Society (ACS) found that the expansion of Medicaid was associated with a statistically significant reduction in early mortality following surgical resection of non-small cell lung cancer (NSCLC) in stages I-III. The study’s results indicate that access to insurance coverage through Medicaid expansion in the United States during a crucial period – in this case during recovery after major surgery – is associated with improved survival rates. The results have been published today in the Journal of the American Medical Association (JAMA) Network Open.
„Lung cancer is the second most commonly diagnosed cancer in the United States and the leading cause of cancer-related deaths. However, the expansion of Medicaid can help improve access to life-saving care. This study quantifies the impact of Medicaid expansion on the survival of vulnerable patient groups and highlights the importance of healthcare and access to timely care.“
– Dr. Leticia Nogueira, Lead Scientist for Health Services Research at the American Cancer Society and lead author of the study
In this study, researchers analyzed data from the National Cancer Database on adults aged 45-64 at the time of diagnosis who underwent surgical resection of NSCLC in stages I-III between 2008 and 2019. The study assessed differences in early mortality (defined as loss of life in the hospital or within 30 or 90 days post-surgery among discharged patients) before and after the implementation of the Affordable Care Act (ACA) between states that expanded Medicaid and those that did not. The researchers also examined differences in stage at diagnosis and comorbidities among individuals operated on for NSCLC in Medicaid expansion and non-expansion states before and after the ACA. The study included 14,984 adult patients, with an average age of 56 years. Just over half (54.6%) of the participants were women, and about six in ten (62.4%) lived in states that expanded Medicaid.
According to the study, 30-day mortality in states that expanded Medicaid decreased from 0.97% in the pre-ACA period to 0.26% in the post-ACA period, and 90-day mortality decreased from 2.63% to 1.32%. In contrast, there was no change in post-discharge mortality in non-expansion states before and after the ACA. Previous studies had shown that individuals with insurance are less likely to delay seeking medical care, which is particularly important during recovery from major cancer surgery when postoperative complications and health concerns often arise. Additionally, there were no differences in stage at diagnosis or comorbidity burden in patients undergoing NSCLC surgery in Medicaid expansion states. Therefore, the decline in postoperative mortality is not attributable to healthier patients undergoing surgery in Medicaid expansion states. These results suggest that Medicaid expansion could be an effective strategy for improving access to healthcare and cancer outcomes.
„This study is further evidence that Medicaid expansion saves lives,“ said Lisa Lacasse, President of ACS CAN. „We know what it takes to end cancer because we know it for all. Most importantly, people with cancer have access to the care they need – including the crucial types of postoperative care analyzed in this study. Medicaid expansion helps more people have this access and a better chance of surviving cancer, which is why ACS CAN has long advocated for this evidence-based policy. ACS CAN continues to urge the ten states that have not expanded Medicaid eligibility to do so quickly. Lives are at stake.“
„Especially after a major procedure like lung cancer surgery, it is crucial that people have access to timely care,“ Nogueira added. „As policymakers consider whether Medicaid should be expanded or updated, our study provides detailed evidence of how coverage leads to positive health outcomes.“
Dr. Robin Yabroff is the lead author of the study. Other ACS authors include Dr. Ahmedin Jemal and Dr. Xuesong Han.