Medicaid expansion linked to better survival in resectable lung cancer, study finds

States that expanded Medicaid eligibility under the Affordable Care Act (ACA) saw meaningful long-term survival gains among younger adults with operable lung cancer, even though patients were not diagnosed at earlier stages, according to a large study published in JAMA Network Open in December 2025. The findings suggest that Medicaid expansion may improve cancer outcomes by strengthening access to timely, comprehensive care.

“In our analysis, states that adopted Medicaid expansion, whether early, on time in 2014, or in later years, had higher population-wide overall survival for patients diagnosed with Stage 1–3A non-small cell lung cancer,” says Rohin Gawdi, M.D., the study’s first author. Gawdi is a surgical resident at Northwell Health in Manhasset, New York, and is currently completing a thoracic surgery research fellowship at Massachusetts General Hospital in Boston.

Lung cancer remains the leading cause of cancer-related death in the United States, and non-small cell lung cancer (NSCLC) accounts for about 85% of cases. For patients with resectable disease — the cancer can be surgically removed — outcomes depend heavily on timely surgery and coordinated care, often involving chemotherapy or radiation. For people without stable health insurance, delays can occur at multiple points, from diagnostic testing to referral and treatment. The ACA aimed to reduce those gaps by expanding Medicaid eligibility to adults with low incomes, although after a Supreme Court decision made the Medicaid expansion optional, states expanded Medicaid at different times, creating a natural way to study its effect. Ten states have still not expanded Medicaid.

To examine how those policy differences translated into outcomes, Gawdi and colleagues analyzed data from the Surveillance, Epidemiology and End Results (SEER) registry. The study included more than 53,000 adults ages 20 to 64 years diagnosed with Stage 1 to 3A NSCLC between 2006 and 2019, excluding most Medicare-eligible patients. States were grouped by when, or if, they expanded Medicaid, and mortality outcomes were tracked for up to four years after diagnosis.

After adjusting for patient and regional factors, the researchers found that Medicaid expansion was associated with lower mortality at two and four years after diagnosis. Survival improvements emerged about three years after policy implementation and were most pronounced in states that expanded coverage in 2014 or earlier. Notably, the share of patients diagnosed with Stage 1 or 2 disease did not increase after Medicaid expansion. This pattern indicates that survival gains were likely tied to better access to surgery, coordinated care and ongoing surveillance rather than earlier detection, according to the researchers.

“These improvements occurred without a major shift in stage at diagnosis, suggesting that expanded insurance coverage may have helped stabilize the health system for all patients moving through the diagnostic and treatment steps required to reach curative-intent surgery,” Gawdi says. “We also observed that the benefits increased over time following an initial delay.”

The study also points to ongoing gaps. Patients living in the poorest counties did not see the same survival benefits, indicating that Medicaid expansion alone may not be enough to overcome deeper structural barriers to care.

“While this study cannot establish causation, it highlights how health-system factors associated with Medicaid expansion were linked to improved outcomes for resectable lung cancer,” Gawdi comments.

As Medicaid eligibility continues to be debated at state and federal levels, the findings suggest that maintaining expansion over time may translate into better outcomes for people with potentially curable lung cancer.