INTRODUCTION: The Affordable Care Act's Medicaid expansion aimed to enhance healthcare access for low-income individuals and minority groups, promoting early screening and treatment to improve health equity. OBJECTIVE: This study examines the impact of Medicaid expansion on lung cancer-specific survival (CSM) and overall mortality (OS) by comparing outcomes in Texas (non-expansion of ACA) and California (expansion of ACA). METHODOLOGY: We conducted a retrospective study using data from SEER cancer registry (2007–2021) to evaluate the impact of Medicaid expansion on lung cancer survival in California (expansion) vs. Texas (non-expansion). The study included adults aged 18–64, with periods split into pre-ACA (2007–2013), one-year washout (2014), and post-ACA (2015–2021). We utilized a DID design and adjusted for important covariates. RESULTS: Among 119,937 individuals with Lung cancer, 52.1% were in California (62,521), while 47.8% were in Texas (57,416). The pre-ACA period included 60,010 individuals (53.1% in California and 46.9% in Texas), and 59,927 patients were in the post-ACA period (51.2% in California and 48.8% in Texas). Overall, Medicaid expansion was associated with a 1.12-point (-1.12, 95% CI –1.46 to –0.77) reduction in the hazard of cancer-specific mortality. The policy was also associated with a 0.81point reduction in the hazard of overall mortality (-0.81, 95% CI –1.06 to –0.57). CONCLUSION: Medicaid expansion was associated with a significant improvement in lung cancer outcomes among individuals with lung cancer in California, which implemented the policy in 2014, compared to Texas, which has not yet implemented the policy.
Akinyemi et al. (Tue,) studied this question.