Medicaid Expansion Linked to Timelier Lung Cancer Surgery and Access to High-Volume Hospitals

Patients with early-stage lung cancer were more likely to receive timely surgery and be treated at high-volume hospitals if they lived in a state that expanded Medicaid under the Affordable Care Act, according to a new study conducted by researchers at MD Anderson Cancer Center in Houston. The research was published last week in The Annals of Thoracic Surgery.

Under the Affordable Care Act, Medicaid expansion offered coverage to low-income adults earning up to 138% of the federal poverty level, but a 2012 Supreme Court decision left the decision whether to expand Medicaid to individual states. According to KFF, 40 states and Washington, D.C., have chosen to expand Medicaid while 10, most of them in the South, have not.

This study evaluated more than 43,000 adults ages 40 to 64 who were diagnosed with stage I or II non-small cell lung cancer (NSCLC) between 2010 and 2016. Researchers used a difference-in-differences analysis to assess how treatment patterns changed before and after Medicaid expansion began in 2014, comparing states that adopted the policy with those that did not.

“Our study’s findings suggest that patients residing in states that expanded Medicaid under the Affordable Care Act had fewer barriers to access lung cancer care following this policy initiative,” Ravi Rajaram, M.D., M.Sc., the study’s senior author and assistant professor of thoracic and cardiovascular surgery at the University of Texas MD Anderson Cancer Center, told MHE in an email interview. “Specifically, these patients underwent surgical resection for their lung cancer in a timelier manner compared to patients in nonexpansion states.”

In expansion states, the rate of surgery within 90 days of diagnosis rose by just over 2%, while the proportion of patients treated at high-volume hospitals increased by nearly 3%. These hospitals, which perform higher numbers of lung cancer resections, have been associated with lower short-term mortality and fewer complications.

“Some prior studies have reported that patients undergoing surgery for lung cancer at higher volume hospitals may experience improved outcomes compared to those at lower volume centers,” Rajaram said. “In our analysis, Medicaid expansion was associated with a higher likelihood of patients receiving lung cancer resection at high-volume hospitals.”

Although national trends showed a gradual increase in delays between diagnosis and treatment, the researchers noted that expansion states experienced a slower decline in timely care. Earlier studies have linked Medicaid expansion to earlier cancer diagnoses and improved survival in multiple tumor types, including lung cancer. For example, results reported last year in JAMA Network Open show that among patients with NSCLC, both 30-day and 90-day postoperative mortality decreased from before the ACA to afterward among those residing in Medicaid expansion states but not among those residing in nonexpansion states.

In their paper, Rajaram and his colleagues suggest that broader insurance coverage may allow more patients to seek care at specialized centers, especially as public access to hospital quality data grows. However, they acknowledged that there is still debate about the exact relationship between hospital volume and better outcomes in lung cancer.

“Whether Medicaid expansion improved short- and long-term surgical and oncologic outcomes in these patients is not known and requires further investigation,” Rajaram added.

These findings contribute to ongoing research on how health policy decisions may affect access to timely, specialized cancer care. They also come at a time when Medicaid expansion remains a politically charged issue, with some states still opting out and others facing uncertainty around future funding and coverage stability.