Disparities in access to cancer surgery after Medicaid expansion.

INTRODUCTION: The Affordable Care Act (ACA) expanded Medicaid eligibility to persons with income up to 138% of the federal poverty line. We investigated how Medicaid expansion (ME) impacted the access to cancer-specific surgical care in the US.

METHODS: We used a nationwide population-based database (SEER) to identify patients with the 8 most prevalent cancers between 2007 and 2015. Adjusted difference-in-differences (DiD) and multivariate regression were used for statistical analysis.

RESULTS: A total of 1,008,074 patients were included. Patients post-ME were diagnosed at an earlier stage (pre-ME, 27.6%; post-ME, 31.1%; P < 0.001), and lack of insurance coverage decreased from 5.5% to 2.6% (P < 0.001). Lower-SES population had improved access to surgical care (attributable benefit +3.18%; P < 0.001). ME was an independent predictor of access-to-surgery (OR, 1.45; P < 0.001), whereas African-American and Hispanic race were negative predictive factors.

CONCLUSION: After ME, the population without insurance coverage decreased. This was associated with earlier cancer diagnosis and improved access to surgery in patients from economically disadvantaged communities.