Medicaid expansion linked to improved NSCLC survival, diagnosis

Medicaid expansion was linked with improved insurance coverage, early-stage diagnosis and overall survival among patients with non–small cell lung cancer (NSCLC), according to a study published in JAMA Network Open.

“These improvements were stronger among residents of less-privileged areas, including rural areas, high-poverty communities, medically underserved areas, and areas characterized by high residential segregation or socioeconomic deprivation and were associated with smaller place-based disparities. Given the higher burden of NSCLC and persistent health disparities in the Medicaid nonexpansion states, Medicaid expansion may support improved cancer outcomes and health equity in these states.”

As of September 2025, 40 states and Washington, D.C., had implemented Medicaid expansion, which was designed to improve health care access and reduce disparities as part of the Affordable Care Act in 2014. In the time since most ACA provisions were implemented, the uninsured rate dropped from 17.8% in 2014 to 9.5% in 2023, which improved cancer care access for patients across demographic groups, the authors of the JAMA Network Open study noted.

“Among patients with lung cancer, previous research showed that Medicaid expansion was associated with reductions in being uninsured, with overall survival, and with reductions in both 30-day and 90-day postoperative mortality following lung cancer surgery,” the authors wrote. “The association of Medicaid expansion with place-based disparities in lung cancer outcomes remains unclear, however.”

In the new study, which included 303,503 patients diagnosed with NSCLC between 2009 and 2019, the authors aimed to fill the knowledge gap by evaluating whether Medicaid expansion was associated with place-based disparities in insurance coverage, early-stage diagnosis, and 3-year overall survival among patients with NSCLC.

Expansion states saw a 5.06-percentage-point increase in health insurance coverage versus 2.87 percentage points in nonexpansion states, for an adjusted difference-in-difference of 2.22 percentage points. In nonmetropolitan counties, coverage increased by 3.38 percentage points, and counties with intermediate or high levels of segregation saw increases of 3.39 and 2.76 percentage points, respectively.

The authors noted that because many Southern states did not expand Medicaid and have higher proportions of racially and economically segregated counties, expansion in these states could help reduce persistent health disparities.

Rates of localized-stage diagnosis and 3-year overall survival were also higher in Medicaid expansion states compared with nonexpansion states, with differences of 1.76 percentage points and 1.89 percentage points, respectively. Greater improvements were seen among patients in socioeconomically disadvantaged areas, including a 4.22-percentage-point increase in 3-year survival in nonmetropolitan counties and a 1.21-percentage-point increase in metropolitan counties.

“In our study, Medicaid expansion was associated with substantially greater decreases in uninsured status and higher 3-year overall survival among patients with NSCLC in rural areas compared with urban areas, while showing significant but similar associations with early-stage diagnosis across both settings,” the authors explained. “These findings suggest that Medicaid expansion is associated with smaller urban-rural disparities in NSCLC care.”