Association of Medicaid Expansion With Timely Treatment and Access to High-Volume Hospitals in Early-Stage Lung Cancer Patients.

Abstract

Medicaid expansion reduced the uninsured rate in non-small cell lung cancer (NSCLC) patients. We aimed to determine whether Medicaid expansion was associated with regionalization of surgical care at high-volume hospitals and timely treatment for early-stage NSCLC patients. Using the National Cancer Database, adults aged 40-64 years with resected stage I-II NSCLC between 2010 and 2016 were identified. High-volume hospitals, defined as those in the highest volume quartile, and time to treatment was measured from the date of diagnosis. Using adjusted difference-in-differences (DID) analyses, NSCLC patients treated in expansion states were compared to those in nonexpansion states before and after this policy's implementation in 2014. We identified 43,151 patients: 19,870 (46.0%) from expansion and 23,281 (54.0%) from nonexpansion states. Though receipt of any treatment within 30 and 90 days of diagnosis decreased in both groups over time, Medicaid expansion was associated with timely treatment in expansion states (P < .01 for both). Although Medicaid expansion was not associated with resection within 30 days of diagnosis (adjusted DID, 1.8; 95% CI, -0.1 to 3.6; P = .078), it was associated with surgery within 90 days (adjusted DID, 2.1; 95% CI, 0.4-3.8; P = .012), and resection at high-volume hospitals (adjusted DID, 2.8; 95% CI, 1.2-4.7; P = .001). In stage I-II NSCLC patients, Medicaid expansion was associated with receipt of timely treatment, including surgery within 90 days of diagnosis, and resection at high-volume hospitals. Additional studies are needed to determine if this policy affected the quality of oncologic care received in this population.