Effect of Medicaid Expansion on Survival for Young Adults With Cancer

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In a study reported in the Journal of Clinical Oncology, Ji et al found that Medicaid expansion through the Affordable Care Act (ACA) has been associated with improved 2-year survival among young adults with cancer, with greater benefits observed in patients with breast cancer, those with stage IV disease, and among racial/ethnic minorities.

Study Details

The study involved data from the National Cancer Database on 345,413 young adults aged 18 to 39 years diagnosed with cancer from 2010 to 2017. Major provisions of the ACA were implemented in 2014. The difference-in-differences (DD) method was used to estimate changes in 2-year overall survival after vs before Medicaid expansion in expansion vs nonexpansion states.

Key Findings

Among all young adults, 2-year overall survival increased from 90.39% preexpansion to 91.85% postexpansion in expansion states vs from 88.98% preexpansion to 90.07% postexpansion in nonexpansion states, with a net increase of 0.55 percentage points (ppt; 95% confidence interval [CI] = 0.13–0.96) being significant.

The benefit associated with expansion was greatest in female patients with breast cancer (DD = 1.20 ppt, 95% CI = 0.27–2.12) among cancer types, and in patients with stage IV disease (DD = 2.56, 95% CI = 0.36–4.77) across cancer stages.

Greater expansion-associated benefit was observed among pooled Hispanic, non-Hispanic Black, and other race patients (DD = 1.01 ppt, 95% CI = 0.14–1.87) vs non-Hispanic White patients (DD = 0.41 ppt, 95% CI = –0.06 to 0.87). Greater benefit was also observed among patients with Charlson comorbidity score of ≥ 2 (DD = 6.48 ppt, 95% CI = 0.81–12.16) vs patients with a score of 0 (DD = 0.44 ppt, 95% CI = 0.005–0.87).

The investigators concluded, “Medicaid expansion under the ACA was associated with an improvement in overall survival among young adults with cancer, with survival benefits most pronounced among patients of underrepresented race and ethnicity and patients with high-risk diseases.”

Xu Ji, PhD, of the Department of Pediatrics, Emory University, and the Aflac Cancer & Blood Disorders Center, Children’s Healthcare of Atlanta, is the corresponding author for the Journal of Clinical Oncology article.

Disclosure: The study was supported by grants from 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®.