To understand the effect of Medicaid Expansion under the Affordable Care Act (ACA) on patterns of surgical care on low-income patients with lung cancer.
All early-stage non small cell lung cancer patients (stage IA-IIB) from Illinois, Indiana, Michigan, Ohio, and Wisconsin were identified from the National Cancer Database (NCDB). Four cohorts were examined: 1) Medicaid/uninsured patients diagnosed five-years prior to Medicaid expansion 2) Medicaid/uninsured diagnosed five-years post Medicaid expansion 3) Privately-insured patients diagnosed five-years prior to Medicaid expansion and 4) Privately-insured patients diagnosed five-years post Medicaid expansion. The primary outcome was overall rate of patients who did not have surgery for curative intent (RS) and time to surgery (TTS) for those who underwent an operation. A hazard model was used to evaluate any differences.
A total of 18156 patients were identified, including 4819 (26.5%)Medicaid/uninsured and 13337 (73.5%) insured. Of these, 11934 (65.7%) patients underwent surgery including 2697(56.0%) Medicaid/uninsured and 9237 (69.2%) insured patients. Adjusting for age at diagnosis, sex, race, median income, comorbidities, grade/stage, and surgical approach, there was no difference in RS between pre-and post-Medicaid expansion in Medicaid/uninsured patients (HR 0.92; 95% CI 0.84-1.02) However, there was a difference in RS in the privately-insured group (HR 0.91; 95% CI 0.86-0.96). For patients who had surgery, there was no difference in TTS between pre-and post-Medicaid patients in the Medicaid/uninsured group (HR 0.93; 95% CI 0.85-1.03) but there was a difference in the privately-insured group (HR 0.9; 95% CI 0.85-0.95).
Medicaid expansion did not improve rates of surgery for curative intent or time to surgery for Medicaid/uninsured non small cell lung cancer patients. However, privately insured patients had a longer time to surgery and lower rate of surgery for curative intent post-expansion.