Medicaid Expansion is Associated with Differences in Local Therapy for Non-small Cell Lung Cancer

Medicaid expansion under the Affordable Care Act aimed to expand healthcare access, improve quality, and reduce costs. The effects of Medicaid expansion on receipt of local therapy for lung cancer are unknown.

We utilized the National Cancer Database to conduct a retrospective analysis of patients with clinical T1-2, N0, M0 non-small cell lung cancer (NSCLC) without neoadjuvant treatment. Patients living in Medicaid expansion states as of January 2014 were compared with patients in non-expansion states between 2010 and 2013 (pre-expansion) and 2016 and 2019 (post-expansion). A difference-in-difference (DID) analysis was used to compare rates of surgery and stereotactic body radiation therapy (SBRT).

Among 149,966 patients, there were 80,514 patients (53.6%) in Medicaid non-expansion states and 69,452 patients (46.3%) in expansion states. Receipt of local therapy (surgery or SBRT) {- 1.6% vs. - 2.8%, DID 1.24% [confidence interval (CI) 0.45-2.02%]} and receipt of surgery (- 7.9% vs. - 9.3%, DID 1.4% [0.46-2.4%]) decreased at a lesser rate in expansion states between 2010-2013 and 2016-2019. Among patients with Medicaid, receipt of local therapy (surgery or SBRT) and surgery increased at a greater rate in expansion states with a stronger treatment effect (18.9% vs. 1.1%, DID 7.8% [76.12-9.4%]; 8.1 vs. 0.12%, DID 8.0% [6.3-9.66%]). Patients who traveled >10 miles decreased at a greater rate in expansion states (3.7% vs. 5.1%, DID - 1.5% [- 2.46 to - 0.35%]).

Based on Medicaid expansion status, states have different changes in local therapy rates for NSCLC. Our data suggest that Medicaid expansion may increase healthcare access in the receipt of first-line treatment for early-stage NSCLC.