Medicaid expansion associated with reduction in early mortality after lung cancer surgery

In a new, national, hospital-based study, researchers at the American Cancer Society (ACS) found that Medicaid expansion was associated with a statistically significant reduction in early mortality following surgical resection of stage I-III non-small cell lung cancer (NSCLC). The study results indicate that access to health insurance coverage via Medicaid expansion in the United States during a crucial period – in this case, during recovery from major surgery – is associated with improved survival. The findings are published today in the Journal of the American Medical Association (JAMA) Network Open.

Lung cancer is the second most commonly diagnosed cancer in the U.S. and the leading cause of cancer-related mortality, but Medicaid expansion can help improve access to lifesaving care. This study quantifies the impact of Medicaid expansion on survival among vulnerable patient populations, demonstrating the importance of healthcare coverage and access to timely care."

Dr. Leticia Nogueira, scientific director, 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 years at the time of diagnosis who underwent surgical resection of stage I-III NSCLC between 2008 and 2019. The study evaluated differences in early mortality (defined as loss of life in-hospital or within 30 or 90 days after surgery among patients discharged from the hospital) before and after implementation of the Affordable Care Act (ACA) between states that did and did not expand Medicaid. Researchers also assessed differences in stage at diagnosis and comorbidities among people in Medicaid expansion and non-expansion states pre- and post-ACA. The study enrolled 14,984 adult patients. The average participant age was 56, just over half (54.6%) of enrollees were women, and about 6 in 10 (62.4%) lived in Medicaid expansion states.

According to the study, in states that expanded Medicaid, 30-day mortality decreased from 0.97% in the pre-ACA period to 0.26% in the post-ACA period, and 90-day mortality dropped from 2.63% to 1.32%. In contrast, there was no change in post-discharge mortality pre- and post-ACA in non-expansion states. Previous studies had shown that individuals with health insurance coverage are less likely to delay seeking care, which is especially important while recovering from major cancer surgery, when postoperative complications and health concerns are common. In addition, there were no differences in stage at diagnosis or comorbidity burden among patients who received surgery for NSCLC in Medicaid expansion states. Therefore, the decrease in post-operatory mortality is not due to healthier patients undergoing surgery in states that expanded Medicaid. These findings indicate that Medicaid expansion may be an effective strategy for improving access to care and cancer outcomes.

"This study is further proof that expanding Medicaid saves lives," said Lisa Lacasse, president of ACS CAN. "We know what we need to do to end cancer as we know it for everyone, most critically of which is that people with cancer have access to the care they need - including the crucial types of post-operative care this study analyzes. Medicaid expansion helps ensure more people have that 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 10 states that have yet to increase Medicaid eligibility to expand access quickly. Lives are at stake."

"Especially after a major procedure like lung cancer surgery, it's crucial that people have access to timely care," Nogueira added. "As policymakers consider whether to expand or update Medicaid, our study details how coverage leads to positive health outcomes."

Dr. Robin Yabroff is senior author of the study. Other ACS authors include Dr. Ahmedin Jemal and Dr. Xuesong Han.