The Impact of Disparities on Minimally Invasive Esophagectomy After the 2014 Affordable Care Act Expansion: A Retrospective Analysis

Abstract

The effect of Affordable Care Act Medicaid expansion on access to minimally invasive esophagectomy (MIE) is unknown. We hypothesize that greater Medicaid coverage resulting from ACA expansion would be associated with improved access to MIE, and performed an analysis of the National Cancer Database, comparing MIE rates in Medicaid expansion states to non-expansion states. MIE was more common in expansion states (30.37%vs 23.88%, P < .001). A multivariable difference-in-differences analysis, however, suggested no effect in MIE rate due to Medicaid expansion. This finding suggests that access to care is more complex than access to insurance. Further study is required to characterize disparities in access to MIE.