The 2014 passage of the Patient Protection and Affordable Care Act (ACA) allowed states to expand Medicaid benefits by modifying the eligibility criteria by which individuals qualify for coverage. Some states have chosen to reduce the income level to enable individuals and families to be eligible for Medicaid. In the decade since ACA became law, 40 states and the District of Columbia have adopted the Medicaid expansion provision of the ACA.
A group of researchers representing the American Cancer Society set out to determine how Medicaid expansion impacted patient care. As described in a recent article in JAMA Network Open, the researchers found that Medicaid expansion significantly benefited patient care and survival.
The study focused on patients with non-small cell lung cancer (NSCLC), a malignancy that healthcare professionals understand access to healthcare as a factor associated with survival following hospital discharge. For cases where NSCLC has not spread beyond the lung and surrounding lymph nodes, treatment involves a complex surgical resection that removes all or part of the lung. Due to the difficulty of the procedure, recovery also presents significant challenges. About 40% of patients experience adverse events within the month following surgery.
Lack of access to healthcare correlates to deaths occurring after surgery and hospital discharge. Because of this known association between healthcare access and postoperative mortality in NSCLC patients, Medicaid expansion could have a notable impact. Also, because some states have adopted Medicaid expansion while others have not, researchers have a straightforward method to tease apart the benefits of Medicaid expansion in this setting.
The researchers extracted data from the National Cancer Database. The study included 14,984 patients aged 45 to 64 during surgical resection for NSCLC. About 62% of the cohort resided in Medicaid expansion states. The study included cases from 2008 to 2019.
In Medicaid expansion states, 30-day and 90-day postoperative mortality decreased after the ACA went into effect. This trend did not occur in nonexpansion states. The authors suggest that Medicaid expansion could provide a viable strategy to increase access to care and subsequently improve outcomes in this vulnerable population.
Sources: JAMA Oncology, JAMA Network Open, Ann Thorac Surg, Chest
