Medicaid expansion is associated with improved survival in patients with resected Merkel cell carcinoma: A National Cancer Database analysis.

Abstract

Medicaid expansion (ME) under the Affordable Care Act sought to improve health care access for low-income individuals, but its impact on Merkel cell carcinoma (MCC) remains unknown. To evaluate whether ME is associated with improved survival among patients with resected MCC. The National Cancer Database (2010-2020) was queried for patients with stage I to III resected MCC. Patients were stratified by state expansion status. Overall survival (OS) was estimated using the Kaplan-Meier method. Multivariable Cox regression identified predictors of OS. Among 14,802 patients, 9014 (60.9%) resided in expansion states. Patients in expansion states presented with more frequent adverse features, including larger tumors (>2 cm: 42.7% vs 38.4%, P = .003), nodal disease (29.3% vs 27.4%, P = .018), and lymphovascular invasion (37.8% vs 33.6%, P < .001). Five-year OS was higher for patients in expansion states with both stage I to II (61.4% vs 58.3%, P = .022) and stage III disease (46.9% vs 44.4%, P = .044). On multivariable analysis, residence in an expansion state (hazard ratio: 0.92, P = .02) and diagnosis during the post-ME era (hazard ratio: 0.87, P < .001) predicted improved survival. Retrospective design and lack of recurrence or treatment timing data. ME was associated with improved stage-for-stage survival for resected MCC, highlighting the importance of expanded insurance coverage in facilitating timely cancer care.