Medicaid Expansion May Improve Survival in NSCLC Following Resection

“Especially after a major procedure like lung cancer surgery, it’s crucial that people have access to timely care. As policymakers consider whether to expand or update Medicaid, our study details how coverage leads to positive health outcomes,” according to Leticia Nogueira, PhD, MPH.

Patients with surgically resected non–small cell lung cancer (NSCLC) had improvements in 30-day and 90-day postoperative survival following Medicaid expansion under the Patient Protection and Affordable Care Act (ACA), according to findings from a cohort study published in JAMA Network.¹

The 30-day postoperative mortality rate went from 0.97% to 0.26% in states that implemented the expansion of Medicaid (P <.001). Across states that did not expand coverage with Medicaid, the 30-day postoperative mortality rate was 0.75% and 0.68% before and after the ACA, respectively (P = .74). There was a significant difference-in-differences of –0.64 percentage points (95% CI, –1.19 to –0.08) between states that expanded Medicaid and those that did not (P = .03).

The 90-day postoperative mortality rate in Medicaid expansion states decreased from 2.63% to 1.32% following the ACA (P <.001). The corresponding rates were 2.43% and 2.20% before and after the ACA, respectively, in states that did not expand coverage with Medicaid (P = .57). Investigators reported a significant difference-in-differences in 90-day postoperative outcomes at –1.08 percentage points (95% CI, –2.08 to –0.08) between Medicaid expansion states and those that did not expand the program (P = .03).

Postoperative mortality in the hospital decreased from 1.41% to 0.77% in Medicaid expansion states following the ACA (P = .004). Additionally, the mortality rate in states that did not expand Medicaid went from 1.49% to 1.20%. It was reported that there was no statistically significant difference-in-differences between states that expanded Medicaid compared with those that did not (P = .34).

“Lung cancer is the second most commonly diagnosed cancer in the United States and the leading cause of cancer-related mortality, but Medicaid expansion can help improve access to lifesaving care,” lead study author Leticia Nogueira, PhD, MPH, scientific director of health services research at the American Cancer Society, said in a press release on these findings.² “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.”

Investigators of this cohort study used the National Cancer Database to determine outcomes among 14,984 patients who underwent surgery for NSCLC from 2008 to 2019.¹ Analysis involved descriptive statistics for comparing study population characteristics based on the Medicaid expansion status of states in which patients lived in. Moreover, investigators assessed how Medicaid expansion correlated with postoperative survival before the ACA in 2008 to 2013 and after the program’s implementation between 2014 and 2019.

The study included patients 45 to 64 years old who received curative lobectomy or pneumonectomy for stage I to III NSCLC in 27 states that expanded Medicaid coverage by 2014 and 16 states that did not increase Medicaid eligibility by 2019.

The mean patient age was 56.3 years. Most patients were female (54.6%), non-Hispanic White (69.2%), and lived in states that expanded access to Medicaid (62.1%). Additionally, those who lived in states that did not expand Medicaid tended to be younger, non-Hispanic Black, uninsured, have stage II disease, and comorbidities that were similar to those who lived in expansion states.

Findings from a sensitivity analysis including patients 18 to 64 years old who received surgery for NSCLC in expansion and non-expansion states were comparable with those reported in the overall population. Additionally, investigators highlighted no significant difference-in-difference results in diagnosis stage or comorbidity prevalence among those who underwent surgery for NSCLC in states that expanded Medicaid or those that did not.

“Especially after a major procedure like lung cancer surgery, it’s crucial that people have access to timely care. As policymakers consider whether to expand or update Medicaid, our study details how coverage leads to positive health outcomes,” Nogueira concluded.²

References

1. Nogueira LM, Boffa DJ, Jemal A, Han X, Yabroff KR. Medicaid expansion under the Affordable Care Act and early mortality following lung cancer surgery. JAMA Network Open. 2024;7(1):e2351529. doi:10.1001/jamanetworkopen.2023.51529
2. Medicaid expansion improves post-surgery survival among adults with non-small cell lung cancer, new study shows. News release.American Cancer Society. January 12, 2024. Accessed January 16, 2024. http://tinyurl.com/e2ybbxc4