A recent study published by Hooda et al in The Annals of Thoracic Surgery suggests that Medicaid expansion under the Affordable Care Act has significantly improved access to timely treatment and high-volume hospitals for patients with early-stage non–small cell lung cancer (NSCLC). These findings underscore the critical role of health-care policy in delivering quality oncologic care.
Key Findings
Medicaid expansion was associated with an increase in lung cancer surgeries performed at high-volume hospitals, which are associated with decreased rates of postoperative complications and in-hospital mortality rates compared with low-volume hospitals. Patients in Medicaid expansion states were more likely to undergo surgery within 90 days of diagnosis compared with those in nonexpansion states.
Although overall treatment rates within 30 and 90 days decreased nationwide, the decline was less pronounced in states that expanded Medicaid, indicating that insurance coverage may play a role in mitigating delays.
“Study findings suggest improved insurance coverage and enhanced access to care may increasingly regionalize oncologic surgical treatment from community-based hospitals to institutions specializing in these operations,” said lead study author Zamaan Hooda, MD, of The University of Texas MD Anderson Cancer Center. “However, the patient benefits of performing surgical resections for NSCLC at high-volume hospitals continue to be a matter of debate as it relates to lung cancer resection.”
Study Details
Researchers analyzed data from the National Cancer Database, identifying 43,151 patients aged 40 to 64 diagnosed with stage I–II NSCLC between 2010 and 2016. They used adjusted difference-in-differences analyses to compare treatment trends before and after Medicaid expansion in 2014. The results showed that Medicaid expansion was associated with a 2.8% increase in lung cancer surgeries performed and a 2.1% increase in surgeries completed within 90 days of diagnosis at high-volume hospitals.
“The increase in resections performed at high-volume hospitals suggests that patients in expansion states may have had more options for surgical care compared to patients in nonexpansion states,” added Dr. Hooda. “With heightened public awareness of hospital outcomes through widely available sources, we speculate that expanded Medicaid coverage may have enabled some patients to seek care at centers they previously could not access.”
Future Implications
Although this study demonstrates a tangible benefit of Medicaid expansion, further research is needed to determine its effect on the quality of oncologic care. Policymakers and health-care providers may use these data to advocate for strategies that improve access to timely and high-quality lung cancer treatment nationwide, noted the researchers.
Medicaid expansion continues to be a hot-button topic, with several states choosing not to accept funding. Moreover, many states that have expanded Medicaid risk losing the ability to offer coverage for currently insured individuals if major budgetary cuts are made at the federal level.
Disclosure: For full disclosures of the study authors, visit annalsthoracicsurgery.org.
