Introduction
The expansion of Medicaid under the Affordable Care Act increased access to health
care for millions of low-income Americans. However, the longer-term impacts of the
policy on cancer outcomes remain unknown. This study examined the impact of Medicaid
expansion on early- and late-stage diagnosis for 4 common cancers (breast, cervical,
colorectal, and lung) using 4 full years of postpolicy data.
Methods
Patients aged 40–64 years diagnosed with breast, cervical, colorectal, or lung cancer
from 2010 to 2017 were identified using the National Cancer Database. Difference-in-difference
analyses compared changes in early-stage and late-stage diagnoses among expansion
states with those among nonexpansion states. Subgroup analyses explored potential
effect modification by insurance type. Data analysis was performed from June to October
2021.
Results
The proportion of early stage diagnosis of breast (difference in difference=1.58,
95% CI=0.89, 2.27), cervical (difference in difference=3.20; 95% CI=0.44, 5.95), colorectal
(difference in difference=1.98; 95% CI=1.18, 2.78), and lung (difference in difference=1.74;
95% CI=0.98, 2.50) cancers increased more in expansion states than in nonexpansion
states, whereas late-stage diagnosis of colorectal (difference in difference= −2.12;
95% CI= −2.98, −1.27) and lung (difference in difference= −1.87; 95% CI= −2.89, −0.84)
cancers decreased more in expansion states following implementation of the Affordable
Care Act. In subgroup analyses, difference-in-difference estimates for all sites and
stages (except late-stage cervical cancer) were significant and larger in magnitude
among Medicaid-insured than among privately insured patients.
Conclusions
Study results highlight the positive impacts of Medicaid expansion on earlier diagnosis
of several cancers for which screening and early detection exist, and subgroup analyses
revealed greater positive effects among Medicaid-insured patients most targeted by
the policy.
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Article Info
Publication History
Published online: July 21, 2022
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© 2022 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.