O.A. Akinyemi1, C. Ogbuehi1, A. Curry1, M. Akula1, K. Hughes1, G. Levy1 1Howard University College Of Medicine, General Surgery, Washington, DC, USA
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 in the United States. This study examines the impact of Medicaid expansion on lung cancer survival (CSS) by comparing outcomes in Texas, which did not adopt Medicaid expansion, to those in California, which fully implemented the policy.
Methods: We conducted a retrospective analysis using data from the SEER Cancer Registry covering the period from 2000 to 2020. The study aimed to determine the impact of Medicaid expansion on lung cancer-specific survival among individuals in California (treated state), which implemented the policy in 2014, compared to Texas (control state), which has not adopted the policy. We employed a Difference-in-Differences (DID) methodology to assess the survival gains among Medicaid-eligible individuals across different racial and ethnic groups.
Results: Among 361,904 individuals with Lung cancer, 60.8% were in California (219,859), while 39.3% were in Texas (142,045). The pre-ACA period included 197,790 individuals (57.6% in California and 42.4% in Texas), and 164,114 patients were in the post-ACA period (64.5 in California and 35.5% in Texas). In the post-ACA implementation period, there was an 11% reduction in the hazard of deaths (HR=0.89, 95% CI 0.88-0.90). Overall, Medicaid expansion was associated with a –15.0% reduction in the hazard of death. Among individuals earning less than $65K, the reduction was –15.3% (95% CI: -20.1% to –10.5%). For Whites, the reduction was –15.8% (95% CI: -20.8% to –10.8%); for Blacks, it was –15.7% (95% CI: -20.7% to –10.8%), and for Hispanics, it was 14.1% (95% CI: -18.7% to –9.7%).
Conclusion: Medicaid expansion was associated with a significant improvement in cancer-specific survival among individuals with lung cancer in California, which implemented the policy in 2014, compared to Texas, which has not yet implemented the policy.