Study Finds Medicaid Expansion May Improve Survival Outcomes for Young Adult Patients With Cancer

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Researchers have discovered that expanded Medicaid coverage under the Affordable Care Act may lead to better survival outcomes for young adult patients aged 18 to 39 years who have been newly diagnosed with cancer—particularly among those who identify as Hispanic or non-Hispanic Black—according to a new study published by Ji et al in the Journal of Clinical Oncology. Additionally, young adult patients with breast cancer and stage IV cancers had pronounced improvements attributable to Affordable Care Act–expanded Medicaid coverage.


Approximately 83,700 young adults were newly diagnosed with cancer in 2020. Historically, young adults have not experienced the same survival improvements over time as pediatric and older populations; they also have had worse prognoses than younger or older cohorts for some cancer types.

A major contributor to these worse survival outcomes is lack of health insurance coverage, which is not uncommon among the young adult population. As of November 2022, 11 states—including Georgia—have not adopted Medicaid expansion under the Affordable Care Act, and South Dakota has adopted but not yet implemented the expansion.

Study Methods and Results

In the nationwide sample of 345,413 young adult patients newly diagnosed with cancer, researchers uncovered that Medicaid expansion under the Affordable Care Act was associated with a significant increase in 2-year survival.

“Using nationwide cancer registry data, our study shows a survival benefit of Medicaid expansion under the Affordable Care Act for young adult patients with cancer, particularly among racial and ethnic minority groups and patients at risk for poor prognosis,” highlighted lead study author Xu Ji, PhD, MSPH, Assistant Professor in the Department of Pediatrics at the School of Medicine and a researcher at the Winship Cancer Institute of Emory University.

Previous research has shown that Affordable Care Act Medicaid expansion may be associated with improved insurance coverage and shifts to early diagnoses in young adults with cancer.

“The current study adds to accumulating evidence of the multiple health benefits of Medicaid expansion, reinforcing the importance of expanding Medicaid in all states,” said senior study author Xuesong Han, PhD, Adjunct Professor in the Department of Epidemiology at the Rollins School of Public Health and a researcher at the Winship Cancer Institute of Emory University, as well as Director of Surveillance and Health Services Research at the American Cancer Society.


By increasing insurance coverage for low-income young adult patients, the Affordable Care Act Medicaid expansion may have the potential to improve access to medical care and, ultimately, health outcomes. However, there has been a dearth of information about young adult patients’ experience with cancer because they are not included in age-based screening guidelines for most cancers with screening services available. Additionally, there has been a lack of empirical evidence on the actual impact of the Affordable Care Act expansion on the young adult patient population—until the present study.

The new study’s findings highlighted the promising role of expanding insurance coverage and increasing access to early detection, quality cancer treatment, and follow-up care as a means to improve survival and reduce disparities in health outcomes among young adult patients with cancer.

“The impact of these data is enormous for young adult [patients] who often come to diagnosis late due to the lack of cancer screening guidelines in their age group,” emphasized study author Sharon Castellino, MD, MSc, Professor in the Department of Pediatrics at the School of Medicine and a researcher at the Winship Cancer Institute of Emory University, as well as Director of Leukemia and Lymphoma at Children’s Healthcare of Atlanta. “Access to medical care for early detection and cancer treatment is afforded by Medicaid expansion programs and is critical to our advancement of care in this young population who often fall between the gaps in our health-care system.”

Disclosure: This study was supported by the National Cancer Institute. For full disclosures of the study authors, visit

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.