Investigators have found that Medicaid expansion under the Affordable Care Act may be associated with a reduced risk of early mortality following surgical resection in patients with non–small cell lung cancer (NSCLC), according to a recent study published by Nogueira et al in JAMA Network Open. The recent findings indicated that access to health insurance coverage via Medicaid expansion during recovery from a major cancer procedure may improve survival.
“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 life-saving care,” highlighted lead study author Leticia Nogueira, PhD, MPH, Scientific Director of Health Services Research at the American Cancer Society (ACS). “This study quantifies the impact of Medicaid expansion on survival among vulnerable patient populations, demonstrating the importance of health-care coverage and access to timely care,” she emphasized.
Study Methods and Results
In the recent national, hospital-based study, the investigators used the National Cancer Database to analyze the outcomes of 14,984 patients aged 45 to 64 years at diagnosis who underwent surgical resection of stage I to III NSCLC between 2008 and 2019. The investigators evaluated differences in the NSCLC stage at diagnosis, comorbidity burden, and the rate of early mortality—defined as death in hospital or within 30 to 90 days post–surgical resection among those discharged from the hospital—prior to and following the implementation of the Affordable Care Act between states that did and did not expand Medicaid coverage. They noted that 62.4% of the patients involved in the study resided in Medicaid expansion states.
Compared with the period prior to the Affordable Care Act, the period following its enactment saw the 30-day mortality rates decrease from 0.97% to 0.26% and 90-day mortality rates decrease from 2.63% to 1.32% in the Medicaid expansion states. In contrast, there were no changes in the postdischarge mortality rates prior to and following the Affordable Care Act in nonexpansion states. Previous studies have shown that patients with health insurance coverage may be less likely to delay seeking care—which is especially important while recovering from major cancer procedure—when postoperative complications and health concerns are common. In addition, there were no statistically significant differences in the stage at diagnosis or comorbidity burden among patients who received surgical resection for NSCLC in Medicaid expansion states. Therefore, the decrease in postsurgical mortality may not be caused by healthier patients undergoing surgery in states that expanded Medicaid.
Conclusions
“This study is further proof that expanding Medicaid saves lives. We know what we need to do to end cancer as we know it for everyone, most critically of which is that [patients] with cancer have access to the care they need—including the crucial types of postoperative care this study analyzes,” underscored Lisa Lacasse, MBA, President of the ACS Cancer Action Network (CAN). “Medicaid expansion helps ensure more [patients] have that access and a better chance of surviving cancer, which is why ACS CAN has long advocated for this evidence-based policy. [The network] continues to urge the 10 states who have yet to increase Medicaid eligibility to expand access quickly. Lives are at stake,” she stressed.
The investigators suggested that Medicaid expansion may be an effective strategy for improving access to care and cancer outcomes.
“Especially after a major procedure like lung cancer surgery, it’s crucial that [patients] have access to timely care. As policymakers consider whether to expand or update Medicaid, our study details how coverage leads to positive health outcomes,” concluded Dr. Nogueira.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
