A recent study by researchers at the American Cancer Society (ACS) showed that Medicaid expansion was associated with an increase in Medicaid coverage, early-stage cancer diagnoses, and improved 2-year survival among individuals aged 65 or older who were diagnosed with cancer. They believe these findings underscore the spillover benefits of Medicaid expansion in supporting low-income elderly populations and the importance of indirect benefits when evaluating Medicaid expansion’s broader impact. These results were presented at the 2025 ASCO Annual Meeting in Chicago.1
In the report, Kewei (Sylvia) Shi, MPH, Associate Scientist, Health Services Research at the American Cancer Society, and colleagues identified patients aged 65 or older using the National Cancer Database. They analyzed data of newly diagnosed patients with cancer between 2010 and 2022 residing in areas with a median household income below 200% of the federal poverty level. The investigators applied a quasi-experimental difference-in-differences design, with multivariable linear probability models, to compare the changes in the percentage of dual-eligible or Medicaid-only coverage, early stage at diagnosis, and 2-year survival after (vs before) Medicaid expansion in expansion states compared with nonexpansion states.
Kewei (Sylvia) Shi, MPH
Study results included a total of 1,461,540 patients with cancer: 881,692 patients from Medicaid expansion states and 579,848 patients from nonexpansion states. After the investigators adjusted for sociodemographic characteristics, the percentage of patients with dual or Medicaid-only coverage increased from 10.3% to 11.3% in expansion states and decreased from 9.4% to 8.1% in nonexpansion states, resulting in a net increase of 1.25 percentage points associated with Medicaid expansion. Differences were more pronounced among patients older than age 85, females, non-Hispanic Black individuals, metropolitan residents, and those with comorbidities.
Early-stage (0, I, II) cancer diagnoses decreased more in nonexpansion states (55.6% to 53.1%) than in expansion states (53.5% to 51.9%), resulting in a net 1.00 percentage points increase. The protective effects of Medicaid expansion were seen to be stronger for lung and bronchial as well as oral cavity and pharyngeal cancers.
The 2-year overall survival rates increased from 58.8% to 62.4% in expansion states and from 59.2% to 62.5% in nonexpansion states, leading to a net benefit of 0.77 percentage point. Improvements were most notable for those with stage IV lung and bronchial, kidney, and bladder cancers.
DISCLOSURE: Ms. Shi reported no conflicts of interest. For full disclosures of the other study authors, visit coi.asco.org.
REFERENCE
1. Shi KS, Ji X, Yabroff R, et al: Spillover effects of Medicaid expansion on insurance coverage, diagnosis, and survival among low-income elderly patients with cancer. 2025 ASCO Annual Meeting. Abstract 1522. Presented June 1, 2025.
