Jose Wilson B Mesquita-Neto1, Peter Cmorej2, Hassan Mouzaihem2, Donald Weaver2, Steve Kim2, Francis I Macedo3. 1. Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine/Barbara-Ann Karmanos Comprehensive Cancer Center, Detroit Medical Center, Detroit, MI, USA. Electronic address: mesquitajw@wayne.edu. 2. Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine/Barbara-Ann Karmanos Comprehensive Cancer Center, Detroit Medical Center, Detroit, MI, USA. 3. Department of Surgery, North Florida Regional Medical Center, University of Central Florida College of Medicine, Gainesville, FL, USA.
Abstract
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.
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.
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