Survival in Young Adults With Cancer Is Associated With Medicaid Expansion Through the Affordable Care Act

Ji, Xu; Shi, Kewei; Mertens, Ann C.; Zhao, Jingxuan; Yabroff, K. Robin; Castellino, Sharon M.; Han, Xuesong

doi:10.1200/jco.22.01742

Cited by 23 publications

(22 citation statements)

References 41 publications

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“…44,49,50 Two NCD analyses, applying a difference-in-difference approach, examined stage of disease at diagnosis and survival in Medicaid expansion versus nonexpansion states. 49,50 During 2011-2016, Medicaid expansion states demonstrated greater shifts to earlier-stage disease at diagnosis, including improvements among non-Hispanic Black AYAs. 50 Subsequently (2010-2017), survival benefits were best for those with higher-stage disease at diagnosis, and among racial and ethnic minoritized populations ( v non-Hispanic White).…”

Section: The Role Of Insurance Ses and The Aca In Aya Outcomesmentioning

confidence: 99%

“…50 Subsequently (2010-2017), survival benefits were best for those with higher-stage disease at diagnosis, and among racial and ethnic minoritized populations ( v non-Hispanic White). 49…”

Section: The Role Of Insurance Ses and The Aca In Aya Outcomesmentioning

confidence: 99%

“…The ACA's Medicaid expansion and DCE are associated with improved health outcomes for AYAs with cancer. 44,49,50 Two NCD analyses, applying a difference-in-difference approach, examined stage of disease at diagnosis and survival in Medicaid expansion versus nonexpansion states. 49,50 During 2011-2016, Medicaid expansion states demonstrated greater shifts to earlier-stage disease at diagnosis, including improvements among non-Hispanic Black AYAs.…”

Section: Stage and Survivalmentioning

confidence: 99%

See 2 more Smart Citations

Access to Care for Adolescents and Young Adults With Cancer in the United States: State of the Literature

Kirchhoff,

Waters,

Chevrier

et al. 2024

JCO

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Access to care remains a persistent challenge for adolescents and young adults (AYAs) with cancer. We review key findings in the science to date. (1) Location of care matters. There is survival benefit for AYAs treated either at a pediatric center or site with special status (eg, Children's Oncology Group, National Cancer Institute [NCI]–designated Comprehensive Cancer Center). (2) Socioeconomic status and insurance require further investigation. Medicaid expansion has had a moderate effect on AYA outcomes. The dependent care expansion benefit has come largely from improvements in coverage for younger populations whose parents have insurance, while some subgroups likely still face insurance gaps. (3) Clinical trial enrollment remains poor, but access may be improving. Numerous barriers and facilitators of clinical trial enrollment include those that are system level and patient level. NCI has established several initiatives over the past decade to improve enrollment, and newer collaboratives have recently brought together multidisciplinary US teams to increase clinical trial enrollment. (4) Effective AYA programs require provider and system flexibility and program reflection. With flexibility comes a need for metrics to assess program effectiveness in the context of the program model. Centers treating AYAs with cancer could submit a subset of metrics (appropriate to their program and/or services) to maintain their status; persistence would require an entity with staying power committed to overseeing the metrics and the system. Substantial clinical and biological advances are anticipated over the next 20 years that will benefit all patients with cancer. In parallel, it is crucial to prioritize research regarding access to health care and cancer care delivery; only with equitable access to care for AYAs can they, too, benefit from these advances.

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Section: The Role Of Insurance Ses and The Aca In Aya Outcomesmentioning

confidence: 99%

“…50 Subsequently (2010-2017), survival benefits were best for those with higher-stage disease at diagnosis, and among racial and ethnic minoritized populations ( v non-Hispanic White). 49…”

Section: The Role Of Insurance Ses and The Aca In Aya Outcomesmentioning

confidence: 99%

Section: Stage and Survivalmentioning

confidence: 99%

See 1 more Smart Citation

Access to Care for Adolescents and Young Adults With Cancer in the United States: State of the Literature

Kirchhoff,

Waters,

Chevrier

et al. 2024

JCO

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“…In an observational study of over 345,000 AYA patients with cancer, two-year overall survival was higher in patients treated in states that expanded Medicaid access through the Affordable Care Act compared with those in states without expansion (net increase of 0.55 percentage points). 2 These data support the importance of increased access to health insurance for AYA cancer survivors.…”

mentioning

confidence: 76%

UpToDate®

2023

Oncology Times

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UpToDate® and Oncology Times are collaborating to present select content synopses on "What's New in Oncology." UpToDate is an evidence-based, clinical support resource used worldwide by healthcare practitioners to make decisions at the point of care. For complete, current "What's New" content, or to become a subscriber for full content access, go to www.uptodate.com. "What's New" abstract information is free for all medical professionals.

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“…Following the implementation of the ACA in 2014, 40 states and the District of Columbia adopted the Medicaid expansion provision of the ACA so far, and 10 states chose not to expand Medicaid, creating a natural experiment for evaluating whether and to what extent Medicaid expansion affects health care access and health outcomes. Previous studies have shown that individuals residing in expansion states who receive a new diagnosis of cancer are more likely to have health insurance coverage, present with early disease stage at the time of diagnosis, and have better overall survival than individuals residing in nonexpansion states …”

Section: Introductionmentioning

confidence: 99%

Medicaid Expansion Under the Affordable Care Act and Early Mortality Following Lung Cancer Surgery

Nogueira,

Boffa,

Jemal

et al. 2024

JAMA Netw Open

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ImportanceMedicaid expansion under the Patient Protection and Affordable Care Act is associated with gains in health insurance coverage, earlier stage diagnosis, and improved survival among patients with cancer.ObjectiveTo examine the association of Medicaid expansion with changes in early mortality among adults undergoing surgical resection of non–small cell lung cancer (NSCLC), a setting in which access to care is a major determinant of survival.Design, Setting, and ParticipantsThis cohort study used the National Cancer Database to identify 14 984 adults 45 to 64 years of age who underwent surgical resection of NSCLC between 2008 and 2019. Analysis was conducted between March 28, 2021, and September 1, 2023.ExposureState of residence Medicaid expansion status.Main Outcomes and MeasuresDescriptive statistics were used to compare study population characteristics by Medicaid expansion status of patients’ state of residence. Difference-in-differences analyses were used to evaluate the association between Medicaid expansion and postoperative mortality before implementation of the ACA (2008-2013) vs after (2014-2019).ResultsAmong 14 984 adults included, the mean (SD) age was 56.3 (5.1) years, 54.6% were women, and 62.1% lived in Medicaid expansion states. Both 30-day (from 0.97% to 0.26%) and 90-day (from 2.63% to 1.32%) postoperative mortality decreased from before the ACA to after among patients residing in Medicaid expansion states (both P &lt; .001) but not in nonexpansion states (30-day mortality before the ACA, 0.75% vs after the ACA, 0.68%; P = .74; and 90-day mortality before the ACA, 2.43% vs after the ACA, 2.20%; P = .57), leading to a difference-in-differences of −0.64 percentage points (95% CI, −1.19 to −0.08; P = .03) for 30-day mortality and −1.08 percentage points (95% CI, −2.08 to −0.08; P = .03) for 90-day mortality. The difference-in-differences for in-hospital mortality was not significant (P = .34) between expansion states (1.41% before the ACA to 0.77% after the ACA; 0.63 percentage point decrease; P = .004) and nonexpansion states (1.49% before the ACA to 1.20% after the ACA; 0.30 percentage point decrease; P = .29).Conclusions and RelevanceIn this cohort study of patients with NSCLC, Medicaid expansion was associated with declines in 30- and 90-day postoperative mortality following hospital discharge. These findings suggest that Medicaid expansion may be an effective strategy for improving access to care and cancer outcomes in this population.

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Survival in Young Adults With Cancer Is Associated With Medicaid Expansion Through the Affordable Care Act

Cited by 23 publications

References 41 publications

Access to Care for Adolescents and Young Adults With Cancer in the United States: State of the Literature

Access to Care for Adolescents and Young Adults With Cancer in the United States: State of the Literature

UpToDate®

Medicaid Expansion Under the Affordable Care Act and Early Mortality Following Lung Cancer Surgery

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