Association between Medicaid Expansion and 5-Year Survival among Individuals Diagnosed with Cancer.

Medicaid expansion is associated with improvements in access to early detection and treatment services, and 2-year overall survival (OS) among individuals with cancer. However, the association with improvements in longer-term survival remains understudied. A difference-in-differences (DD) approach was used to examine changes in 5-year cause-specific survival and OS following Medicaid expansion. A total of 1,423,983 cancer cases diagnosed between 2007 and 2008 and 2014 and 2015 among adults 18 to 59 years of age residing in 26 expansion and 12 non-expansion states were included. Improvements in cause-specific survival were significantly greater in expansion states among individuals residing in rural [DD: 2.55 percentage point (ppt); 95% confidence interval (CI), 0.23-4.86] and high-poverty communities (DD: 1.54 ppt; 95% CI, 0.30-2.77), non-Hispanic White individuals (DD: 0.37 ppt; 95% CI, 0.05-0.70), and those with pancreatic (DD: 2.60 ppt; 95% CI, 0.86-4.34), lung (DD: 1.32 ppt; 95% CI, 0.30-2.34), and colorectal cancers (DD: 1.31 ppt; 95% CI, 0.26-2.37). Results were similar for OS. These findings underscore the importance of Medicaid expansion in mitigating disparities in survival outcomes. SIGNIFICANCE: Improvements in 5-year cause-specific survival and OS were greater in Medicaid expansion than non-expansion states among individuals residing in rural and high-poverty communities and among individuals diagnosed with cancers that generally have a worse prognosis, emphasizing the importance of Medicaid expansion in mitigating disparities in survival outcomes. See related commentary by Paskett, p. 2404.