Medicaid Expansion and Cervical Cancer Survival: A Comparative Analysis of Expansion Compared With Non-expansion States Using the SEER Registry [ID 2683647

Abstract

INTRODUCTION: Medicaid expansion under the Affordable Care Act sought to improve access to care for millions of uninsured Americans. The implications of this policy change on patients with cervical cancer, a condition disproportionately affecting socioeconomically disadvantaged women, remains underinvestigated. This study explores the effect of Medicaid expansion on cancer-specific survival. METHODS: Using the SEER registry, we retrospectively analyzed cervical cancer patients from a non-expansion state (Georgia), and states that experienced Medicaid expansion (California, Connecticut, Louisiana, etc.). The study spans from 2000 to 2020. We divided the data into pre-ACA (before 2010) and post-ACA (after 2010) periods. Cancer-specific survival was our primary outcome. A difference-in-differences analysis was conducted, adjusting for age, race, income, disease stage, marital status, and regional characteristics. RESULTS: Among 63,796 cervical cancer patients, 55,683 (87.3%) were from Medicaid expansion states and 8,184 (12.7%) from non-expansion Georgia. The 5-year survival was 68.5% in expansion states versus 68.4% in Georgia (P>.05). Difference-in-differences analysis revealed no significant effect of policy implementation on cancer-specific survival (hazard ratio [HR] 1.01; 95% CI, 0.90–1.13). Surgical treatment significantly predicted improved survival (HR 0.46; 95% CI, 0.44–0.49). Black women had lower survival than White women (HR 1.18; 95% CI, 1.12–1.25). CONCLUSION: Medicaid expansion under the Affordable Care Act showed no significant effect on cervical cancer-specific survival. Surgical treatment improved survival, while Black women experienced comparatively lower survival rates.