Impact of Medicaid Expansion Under the Affordable Care Act on Receipt of Surgery for Breast Cancer.

Abstract

Objective:To determine whether Medicaid expansion under the 2010 Affordable Care Act affected rates of breast cancer surgery.Background:Data regarding the impact of Medicaid expansion on access to surgical treatment of breast cancer are limited.Methods:Patients in the National Cancer Database diagnosed with non-metastatic breast cancer between January 1, 2010 and December 31, 2017 and residing in a state that expanded Medicaid in January 2014 or in a state that opted out of expansion were included. A quasi-experimental, difference-in-differences (DID) approach was used to assess rate of omission of surgical treatment.Results:Of 624,237 patients diagnosed with invasive breast cancer, 24,728 (4%) patients did not undergo surgical treatment. Overall, no significant differences in rates of omission of surgery over time were seen based on Medicaid expansion status. Significant findings were noted based on patient residential location. In rural areas, Medicaid expansion was associated with lower rates of omission of surgery (adjusted DID −2.47%, 95% confidence interval [CI] −4.01% to −0.94%; P = 0.002). In urban area, rates of omission of surgery increased over time for both groups, but the relative increase was lower in expansion states (adjusted DID −0.72%, 95% CI −1.25% to −0.20%; P = 0.007). In metro areas, changes in rates of surgery over time were comparable across expansion and non-expansion states (adjusted DID −0.08%, 95% CI −0.32% to 0.16%; P = 0.512).Conclusions:Medicaid expansion had no measurable effect on the receipt of surgery for breast cancer in the overall cohort. Medicaid expansion was associated with higher rates of surgery in rural areas, representing the minority of the population.