Impact and Durability of the Affordable Care Act Medicaid Expansion on Lung Cancer Treatment

Medicaid expansion began in 2014 after passage of the Affordable Care Act; however, the impact and durability of the effects on lung cancer treatment utilization are poorly defined. We aimed to determine whether there is a persistent difference in utilization of lung resection, lung biopsy, and nonoperative treatment of lung cancer in states participating in Medicaid expansion compared with states that are not.

A retrospective cohort study was completed analyzing the difference in utilization between Medicaid expansion states and non-expansion states in 2012-2013, 2016-2017, and 2019. Patients diagnosed with and treated for lung cancer in the states of North Carolina and Florida (non-expansion states) and Maryland and New Jersey (expansion states) were included. A difference-in-difference (DID) analysis was used.

In the immediate postexpansion period (2016-2017), DID analysis revealed increased utilization in expansion states with an adjusted DID of 0.50 lung resections/100,000 persons (P = .002) and an adjusted DID of 0.76 lung biopsies/100,000 persons (P = .001). A persistent increase in utilization was found in the delayed postexpansion period (2019), with an adjusted DID of 0.51 lung resections/100,000 persons (P = .008) and an adjusted DID of 0.84 lung biopsies/100,000 persons (P = .021). No significant difference between groups was observed in the utilization of stereotactic body radiation therapy or chemotherapy.

In our cohort, Medicaid expansion was associated with increased utilization of procedural care for the management of lung cancer, including percutaneous biopsies and surgical resection.