Impact Of Medicaid Expansion Research Articles

ASO Visual Abstract: The Impact of Medicaid Expansion on Early Stage Pancreatic Adenocarcinoma at High- versus Low-Volume Facilities.

ASO Visual Abstract: The Impact of Medicaid Expansion on Early Stage Pancreatic Adenocarcinoma at High- versus Low-Volume Facilities.

Postpartum Medicaid coverage and outpatient care utilization among low-income birthing individuals in Oregon: impact of Medicaid expansion.

This study examined the effect of Medicaid expansion in Oregon on duration of Medicaid enrollment and outpatient care utilization for low-income individuals during the postpartum period. We linked Oregon birth certificates, Medicaid enrollment files, and claims to identify postpartum individuals (N = 73,669) who gave birth between 2011 and 2015. We created one pre-Medicaid expansion (2011-2012) and two post-expansion (2014-2015) cohorts (i.e., previously covered and newly covered by Medicaid). We used ordinary least squares and negative binomial regression models to examine changes in postpartum coverage duration and number of outpatient visits within a year of delivery for the post-expansion cohorts compared to the pre-expansion cohort. We examined monthly and overall changes in outpatient utilization during 0-2 months, 3-6 months, and 7-12 months after delivery. Postpartum coverage duration increased by 3.14 months and 2.78 months for the post-Medicaid expansion previously enrolled and newly enrolled cohorts (p < 0.001), respectively. Overall outpatient care utilization increased by 0.06, 0.19, and 0.34 visits per person for the previously covered cohort and 0.12, 0.13, and 0.26 visits per person for newly covered cohort during 0-2 months, 3-6 months, and 7-12 months, respectively. Monthly change in utilization increased by 0.006 (0-2 months) and 0.004 (3-6 months) visits per person for post-Medicaid previously enrolled cohort and decreased by 0.003 (0-2 months) and 0.02 (7-12 months) visits per person among newly enrolled cohort. Medicaid expansion increased insurance coverage duration and outpatient care utilization during postpartum period in Oregon, potentially contributing to reductions in pregnancy-related mortality and morbidities among birthing individuals.

The Impact of Medicaid Expansion on Patients with Cancer in the United States: A Review.

Since 2014, American states have had the option to expand their Medicaid programs as part of the Affordable Care Act (ACA), which was signed into law by former President Barack H. Obama in 2010. Emerging research has found that Medicaid expansion has had a significant impact on patients with cancer, who often face significant financial barriers to receiving the care they need. In this review, we aim to provide a comprehensive examination of the research conducted thus far on the impact of Medicaid expansion on patients with cancer. We begin with a discussion of the history of Medicaid expansion and the key features of the ACA that facilitated it. We then review the literature, analyzing studies that have investigated the impact of Medicaid expansion on cancer patients in terms of access to care, quality of care, and health outcomes. Our findings suggest that Medicaid expansion has had a positive impact on patients with cancer in a number of ways. Patients in expansion states are more likely to receive timely cancer screening and diagnoses, and are more likely to receive appropriate cancer-directed treatment. Additionally, Medicaid expansion has been associated with improvements in cancer-related health outcomes, including improved survival rates. However, limitations and gaps in the current research on the impact of Medicaid expansion on patients with cancer exist, including a lack of long-term data on health outcomes. Additionally, further research is needed to better understand the mechanisms through which Medicaid expansion impacts cancer care.

The Impact of Medicaid Expansion on Early-Stage Pancreatic Adenocarcinoma at High- Versus Low-Volume Facilities.

While Medicaid Expansion (ME) has improved healthcare access, disparities in outcomes after volume-dependent surgical care persist. We sought to characterize the impact of ME on postoperative outcomes among patients undergoing resection for pancreatic ductal adenocarcinoma (PDAC) at high-volume (HVF) versus low-volume (LVF) facilities. Patients who underwent resection for PDAC were identified from the National Cancer Database (NCDB; 2011-2018). HVF was defined as ≥20 resections/year. Patients were divided into pre-and post-ME cohorts, and the primary outcome was textbook oncologic outcomes (TOO). Difference-in-difference (DID) analysis was used to assess changes in TOO achievement among patients living in ME versus non-ME states. Among 33,764 patients who underwent resection of PDAC, 19.1% (n=6461) were treated at HVF. Rates of TOO achievement were higher at HVF (HVF: 45.7% vs. LVF: 32.8%; p<0.001). On multivariable analysis, undergoing surgery at HVF was associated with higher odds of achieving TOO (odds ratio [OR] 1.60, 95% confidence interval [CI] 1.49-1.72) and improved overall survival (OS) [hazard ratio (HR) 0.96, 95% CI 0.92-0.99]. Compared with patients living in non-ME states, individuals living in ME states were more likely to achieve TOO on adjusted DID analysis (5.4%, p=0.041). Although rates of TOO achievement did not improve after ME at HVF (3.7%, p=0.574), ME contributed to markedly higher rates of TOO among patients treated at LVF (6.7%, p=0.022). Although outcomes for PDAC remain volume-dependent, ME has contributed to significant improvement in TOO achievement among patients treated at LVF. These data highlight the impact of ME on reducing disparities in surgical outcomes relative to site of care.

Impact of Medicaid expansion on inclusion of medications for opioid use disorder in homeless adults' treatment plans

IntroductionPeople experiencing homelessness (PEH) bear disproportionate opioid mortality. This article aims to determine how state Medicaid expansion under the Affordable Care Act impacted the inclusion of medications for opioid use disorder (MOUD) in treatment plans for housed versus homeless individuals. MethodsThe Treatment Episodes Data Set (TEDS) provided data on 6,878,044 U.S. treatment admissions between 2006 and 2019. Difference-in-differences analysis compared MOUD treatment plans and Medicaid enrollment for housed versus homeless clients in states that did and did not expand Medicaid. ResultsMedicaid expansion was associated with a 35.2 (95 % CI, 11.9 to 58.4) percentage point increase in Medicaid enrollment and an 8.51 (95 % CI, 1.13 to 15.9) percentage point increase in MOUD-inclusive treatment plans for housed and homeless clients alike. Yet the pre-existing MOUD disparity persisted, with PEH being 11.8 (95 % CI, −18.6 to −5.07) percentage points less likely to have MOUD-inclusive treatment plans. ConclusionsMedicaid expansion may be an effective tool for increasing MOUD treatment plans for PEH in the 11 states that have not yet implemented the policy, but additional efforts to increase MOUD initiation for PEH will be necessary for closing their treatment gap.

ASO Author Reflections: The Impact of Medicaid Expansion on Early-Stage Hepatocellular Carcinoma Care.

ASO Author Reflections: The Impact of Medicaid Expansion on Early-Stage Hepatocellular Carcinoma Care.

The Impact of Medicaid Expansion on Early-Stage Hepatocellular Carcinoma Care.

The impact of Medicaid expansion (ME) on hepatocellular carcinoma (HCC) remains controversial, and heterogeneous effects on care processes may relate to sociodemographic factors. We sought to evaluate the association between ME and receipt of surgery in early-stage HCC. Patients diagnosed with early-stage HCC between 40 and 64 years of age were identified from the National Cancer Database and divided into pre- (2004-2012)and post- (2015-2017) expansion cohorts. Logistic regressionwas used to identify predictors of surgical treatment. Difference-in-difference (DID) analysis assessed changes in surgical treatment between patients living in ME and non-ME states. Among 19,745 patients, 12,220 (61.9%) were diagnosed before MEand 7525 (38.1%) after. Although overall utilization of surgery decreased after expansion (ME, pre-expansion: 62.2% versus post-expansion: 51.6%; non-ME, pre-expansion: 62.1% versus post-expansion: 50.8%, p < 0.001), this trend varied relative to insurance status. Notably, receipt of surgery increased among uninsured/Medicaid patients living in ME states after expansion (pre-expansion: 48.1%, post-expansion: 52.3%, p < 0.001). Moreover, treatment at academic or high-volume facilities increased the likelihood of undergoing surgery before expansion. After expansion, treatment at anacademic facility and living in anME state (OR 1.28, 95% CI 1.07-1.54, p < 0.01) were predictors of surgical treatment. DID analysis demonstrated increased utilization of surgery for uninsured/Medicaid patients living in ME states relative to non-ME states (uninsured/Medicaid: 6.4%, p < 0.05), although no differences were noted among patients withother insurance statuses (overall: 0.7%, private: -2.0%, other: 0.3%, all p > 0.05). Implementation of ME heterogeneously impacted utilization of care in early-stage HCC. Notably, uninsured/Medicaid patients residing in ME states demonstrated increased utilization of surgical treatment after expansion.

Impact of Medicaid expansion on outcomes after abdominal aortic aneurysm repair

ObjectiveLack of insurance has been independently associated with an increased risk of in-hospital mortality after abdominal aortic aneurysm repair, possibly due to worse control of comorbidities and delays in diagnosis and treatment. Medicaid expansion has improved insurance rates and access to care, potentially benefiting these patients. We sought to assess the association between Medicaid expansion and outcomes after abdominal aortic aneurysm repair. MethodsA retrospective analysis of Healthcare Cost and Utilization Project State Inpatient Databases data from 14 states between 2012 and 2018 was conducted. The sample was restricted to first-record abdominal aortic aneurysm repairs in adults under age 65 in states that expanded Medicaid on January 1, 2014 (Medicaid expansion group) or had not expanded before December 31, 2018 (non-expansion group). The Medicaid expansion and non-expansion groups were compared between pre-expansion (2012-2013) and post-expansion (2014-2018) time periods to assess baseline demographic and operative differences. We used difference-in-differences multivariable logistic regression adjusted for patient factors, open vs endovascular repair, and standard errors clustered by state. Our primary outcome was in-hospital mortality. Outcomes were stratified by insurance type. ResultsWe examined 8995 patients undergoing abdominal aortic aneurysm repair, including 3789 (42.1%) in non-expansion states and 5206 (57.9%) in Medicaid expansion states. Rates of Medicaid insurance were unchanged in non-expansion states but increased in Medicaid expansion states post-expansion (non-expansion: 10.9% to 9.8%; P = .346; expansion: 9.7% to 19.7%; P < .001). One in 10 patients from both non-expansion and Medicaid expansion states presented with ruptured aneurysms, which did not change over time. Rates of open repair decreased in both non-expansion and Medicaid expansion states over time (non-expansion: 25.1% to 19.2%; P < .001; expansion: 25.2% to 18.4%; P < .001). On adjusted difference-in-differences analysis between expansion and non-expansion states pre-to post-expansion, Medicaid expansion was associated with a 1.02% absolute reduction in in-hospital mortality among all patients (95% confidence interval, −1.87% to −0.17%; P = .019). Additionally, among patients who were either on Medicaid or were uninsured (ie, the patients most likely to be impacted by Medicaid expansion), a larger 4.17% decrease in in-hospital mortality was observed (95% confidence interval, −6.47% to −1.87%; P < .001). In contrast, no significant difference-in-difference in mortality was observed for privately insured patients. ConclusionsMedicaid expansion was associated with decreased in-hospital mortality after abdominal aortic aneurysm repair among all patients and particularly among patients who were either on Medicaid or were uninsured. Our results provide support for improved access to care for patients undergoing abdominal aortic aneurysm repair through Medicaid expansion.

The impact of Medicaid expansion on spending and utilization by older low-income Medicare beneficiaries.

To examine indirect spillover effects of Affordable Care Act (ACA) Medicaid expansions to working-age adults on health care coverage, spending, and utilization by older low-income Medicare beneficiaries. 2010-2018 Health and Retirement Study survey data linked to annual Medicare beneficiary summary files. We estimated individual-level difference-in-differences models of total spending for inpatient, institutional outpatient, physician/professional provider services; inpatient stays, outpatient visits, physician visits; and Medicaid and Part A and B Medicare coverage. We compared changes in outcomes before and after Medicaid expansion in expansion versus nonexpansion states. The sample included low-income respondents aged 69 and older with linked Medicare data, enrolled in full-year traditional Medicare, and residing in the community. ACA Medicaid expansion was associated with a 9.8 percentage point increase in Medicaid coverage (95% CI: 0.020-0.176), a 4.4 percentage point increase in having any institutional outpatient spending (95% CI: 0.005-0.083), and a positive but statistically insignificant 2.4 percentage point change in Part B enrollment (95% CI: -0.003 to 0.050, p = 0.079). ACA Medicaid expansion was associated with more institutional outpatient spending among older low-income Medicare beneficiaries. Increased care costs should be weighed against potential benefits from increased realized access to care.

Medicaid expansion, chemotherapy delays, and racial disparities among women with early-stage breast cancer.

Medicaid expansion under the Affordable Care Actextends eligibility for participating states and has been associated with improved outcomes by facilitating access to care. Delayed initiation of adjuvant chemotherapy is associated with worse outcomes among patients with early-stage breast cancer (BC). The impact of Medicaid expansion in narrowing delays by race and ethnicity has not been studied, to our knowledge. This was a population-based study using the National Cancer Database. Patients diagnosed with primary early-stage BC between 2007 and 2017 residing in states that underwent Medicaid expansion in January 2014 were included. Time to chemotherapy initiation and proportion of patients experiencing chemotherapy delays (>60 days) were evaluated using difference-in-difference and Cox proportional hazards models in preexpansion and postexpansion periods according to race and ethnicity. A total 100 643 patients were included (63 313 preexpansion and 37 330 postexpansion). After Medicaid expansion, the proportion of patients experiencing chemotherapy initiation delay decreased from 23.4% to 19.4%. The absolute decrease was 3.2, 5.3, 6.4, and 4.8 percentage points (ppt) for Black, Hispanic, White, and Other patients. Compared with White patients, statistically significant adjusted difference-in-differences were observed for Black (-2.1 ppt, 95% confidence interval [CI] = -3.7% to -0.5%) and Hispanic patients (-3.2 ppt, 95% CI = -5.6% to -0.9%). Statistically significant reductions in time to chemotherapy between expansion periods were observed among White patients (adjusted hazard ratio = .11, 95% CI = 1.09 to 1.12) and those belonging to racialized groups (adjusted hazard ratio = 1.14, 95% CI = 1.11 to 1.17). Among patients with early-stage BC, Medicaid expansion was associated with a reduction in racial disparities by decreasing the gap in the proportion of Black and Hispanic patients experiencing delays in adjuvant chemotherapy initiation.

Impact of Medicaid Expansion on Stage at Diagnosis for US Adults with Pancreatic Cancer: a Population-Based Study.

We evaluated whether Medicaid expansion is associated with earlier stage at diagnosis for pancreatic cancer taking into account key demographic, clinical, and geographic factors. We obtained Surveillance, Epidemiology, and End-Results (SEER-18) data on individuals diagnosed with pancreatic cancer from 2007 to 2016 (< 65years of age). We defined non-metastatic as either local or regional disease (vs. metastatic disease). To estimate the association of Medicaid expansion with pancreatic cancer stage at diagnosis, we used a difference-in-differences model, at the individual level, comparing those from early-adopting states in 2014 to non-early-adopting states. We utilized cluster-robust standard errors and explored the role of demographic factors (race, sex, insurance at diagnosis), clinical indicator (disease in the head of the pancreas), and county characteristics (Urban Influence Code, Social Deprivation Index). In the univariable setting, the probability of non-metastatic disease at diagnosis increased by 3.9 percentage points (ppt) for those from Medicaid expansion states post-expansion (n = 36,609). After adjustment for covariates, the ppt was attenuated to 2.7. Of particular note, we observed evidence of interactions with sex and race. The beneficial effect was less pronounced for men (increase in the probability of non-metastatic stage at diagnosis by 2.1ppt) than women (3.6ppt) and non-existent for blacks (- 3.1ppt) compared to whites (4.9ppt) and other races (4.8ppt). Medicaid expansion is associated with increased probability of non-metastatic stage at diagnosis for pancreatic cancer; however, this beneficial effect is not uniform across sex and race. This underscores the need to investigate the impact of policy and implementation strategies on pancreatic cancer survival disparities.

Changes in receipt of adjuvant brachytherapy for endometrial cancer patients before and after affordable care act: The impact of Medicaid expansion.

For patients with high-intermediate risk (HIR) endometrial cancer, adjuvant radiation (RT) reduces the risk of recurrence, but many patients do not receive RT. Under the Affordable Care Act (ACA), most states expanded Medicaid coverage. Our hypothesis was patients would be more likely to receive indicated adjuvant RT in states that expanded Medicaid compared with patients in states that did not expand Medicaid. National Cancer Database (NCDB) was used to identify patients aged 40-64 years with HIR endometrial adenocarcinoma, stage IA and grade 3 or stage IB and grade 1 or 2, diagnosed from 2010-2018. We conducted a difference-in-differences (DID) cross-sectional retrospective analysis comparing receipt of adjuvant RT among patients residing in Medicaid expansion and non-expansion states before and after ACA implementation (January 2014). Expansion states had higher rates of adjuvant RT prior to January 2014 compared with non-expansion states (49.21% vs. 36.46%), and the proportion of patients who received adjuvant RT increased over the study period across both Medicaid expansion and non-expansion states. After Medicaid expansion, the non-expansion states had a larger absolute increase in adjuvant radiation resulting in a non-significant change in the difference in adjuvant radiation rates compared with baseline (crude increase: 9.63% vs. 7.45%, adjusted DID: -2.68 [95% CI: -7.12-1.75], p = 0.236). Medicaid expansion is likely not the most significant factor affecting access or receipt of adjuvant RT for HIR endometrial cancer patients. Further study could help inform policy and efforts to ensure all patients have access to guideline-recommended RT.

Impact of Medicaid expansion under the Patient Protection and Affordable Care Act on lung cancer care in the US.

Healthcare disparities significantly affect access to care and outcomes in lung cancer patients. The Patient Protection and Affordable Care Act (ACA) Medicaid expansion (ME) was enacted with the aim of improving access to quality and affordable healthcare. This study aims to determine the impact of ME on access to care and outcomes for patients with lung cancer. We conducted a retrospective analysis of adults (ages 40-64 years) diagnosed with non-small cell lung cancer (NSCLC) in the National Cancer Database between 2009-2019. The study population was divided into a pre-expansion era (A: 2009-2013) and a post-expansion era (B: 2015-2019). The exposure of interest was residence in a state that expanded Medicaid in 2014 (ME) vs. non-expansion (NE). Outcomes were insurance coverage, clinical stage at diagnosis, treatment facility, and survival. Propensity score analysis was used to determine the association between ME and survival. A total of 202,003 patients were included (era B, 51.6%). The median age was 58 years, the majority of patients were male (53.0%), White (79.7%), had no comorbidities (62.0%) and adenocarcinoma (57.4%). From era A to B, insurance coverage increased to 96.7% (+6.6%), stage I disease to 25.3% (+6.5%), and treatment at an academic facility to 43.9% (+3.5%) in the ME group. For the NE group, the increases were up to 88.3% (+4.3%), 21.6% (+4.0%), and 28.6% (+0.2%), respectively. The increase in stage I cancer diagnosis was most noticeable in females. Following risk adjustment, era B was associated with an improvement in survival outcomes irrespective of ME status. Disparities in lung cancer care seem to have improved after ME. Ongoing monitoring is still necessary to confirm the program's long-term impact on lung cancer survival.

Evaluating Changes in Surgical Outcomes for Patients With Inflammatory Bowel Disease Following Medicaid Expansion.

Little is known about the impact of Medicaid expansion on the surgical care of inflammatory bowel disease. We sought to determine whether Medicaid expansion is associated with improved postsurgical outcomes for patients with inflammatory bowel disease undergoing a colorectal resection. We performed a risk-adjusted difference-in-difference study examining postsurgical outcomes for patients ages 26 to 64 with Crohn's disease or ulcerative colitis undergoing a colorectal resection across 15 states that did and did not expand Medicaid before (2012-2013) and after (2016-2018) policy reform. Primary study outcomes included 30-day readmission and postoperative complication. Study population included 11 394 patients with inflammatory bowel disease that underwent a colorectal resection. States that underwent Medicaid expansion were associated with a rise in Medicaid enrollment following policy reform (11.8% pre-Medicaid expansion vs 19.7% post-Medicaid expansion). Difference-in-difference analysis revealed a statistically significant lower odds of 30-day readmission in patients undergoing a colorectal resection in expansion states following policy reform relative to patients in nonexpansion states prior to reform (odds ratio, 0.56; 95% confidence interval, 0.36-0.86). No changes in odds of postoperative complication were noted across expansion and nonexpansion states. Medicaid expansion is associated with a rise in Medicaid enrollment in expansion states following policy reform. There were greater improvements in postoperative outcomes associated with patients in expansion states following policy reform relative to patients in nonexpansion states prior to reform, which may have been related to improved perioperative care and medical management.

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

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.

Medicaid expansion increases survival for patients with cancer.

Medicaid expansion increases survival for patients with cancer.

The Impact of Medicaid Expansion on Outcomes After Abdominal Aortic Aneurysm Repair

The Impact of Medicaid Expansion on Outcomes After Abdominal Aortic Aneurysm Repair

Impact of Medicaid Expansion on Incidence and Mortality from Gastric and Esophageal Cancer.

Individuals in Medicaid expanded states have increased access to treatment for medical conditions and other health care resources. Esophageal and gastric cancer are associated with several modifiable risk factors (e.g. smoking, drinking, Helicobacter pylori infection). The impact of Medicaid expansion on these cancers incidence and mortality remains uninvestigated. We evaluated the association between Medicaid expansion and gastric and esophageal cancer incidence and mortality in adults aged 25-64. We employed an observational design using a difference-in-differences method with state level data, from 2010 to 2017. Annual, age-adjusted gastric and esophageal cancer incidence and mortality rates, from the CDC Wonder Database, were analyzed. Rates were adjusted for by several socio-demographic factors. Expansion and non-expansion states were similar in percent Hispanic ethnicity and female gender. The non-expansion states had significantly higher proportion of Black race, diabetics, obese persons, smokers, and those living below the federal poverty line. Adjusted analyses demonstrate that expansion states had significantly fewer new cases of gastric cancer: -1.6 (95% CI 0.2-3.5; P = 0.08) per 1,000,000 persons per year. No significant association was seen between Medicaid expansion and gastric cancer mortality (0.46 [95% CI -0.08 to 0.17;P = 0.46]) and esophageal cancer incidence (0.8 [95% CI -0.08 to 0.24; P = 0.33]) and mortality (1.0 [95% CI -0.06 to 0.26; P = 0.21]) in multivariable analyses. States that adopted Medicaid expansion saw a decrease in gastric cancer incidence when compared to states that did not expand Medicaid. Though several factors may influence gastric cancer incidence, this association is important to consider during health policy negotiations.

The Impact of Medicaid Expansion on Head and Neck Malignancies Presentation and Survival.

Under the Affordable Care Act (ACA), Medicaid expansion became effective in states that have adopted it. We aim to examine its impact on head and neck cancers. A retrospective study that utilizes the Surveillance, Epidemiology, and End Results database, 2010-2016. Study population included patients with head and neck squamous cell carcinoma (HNSCC), differentiated thyroid carcinoma, and head and neck cutaneous melanoma. The objective is to examine disease-specific survival before and after Medicaid expansion. In states that adopted Medicaid expansion, the ratio of Medicaid: uninsured patients increased from 3:1 to 9:1 (p< 0.001). In states that did not adopt Medicaid expansion, the ratio increased from 1:1 to 2:1 (p< 0.001), making the increase in Medicaid coverage in states that adopted the expansion significantly higher (p< 0.001). Patients diagnosed with HNSCC before the expansion had worse survival (hazard ratio [HR]: 1.24, 95% confidence interval: 1.11, 1.39, p< 0.001) in states that adopted Medicaid expansion. Early data indicate that implementation of ACA improved disease-specific survival of patients with HNSCC. 3 Laryngoscope, 133:1409-1414, 2023.

Impact of Medicaid expansion on postoperative mortality in women with gynecologic cancer: a difference-in-difference analysis (020)

Objectives: To compare 30 and 90-day postoperative mortality after surgery for gynecologic malignancy before and after the advent of Medicaid expansion in 2014 in states which did and did not expand Medicaid using a difference-in-difference (DID) analysis. Methods: We included women aged 40-64 years diagnosed with a primary endometrial, ovarian, or cervical malignancy in the National Cancer Database between 2010 and 2016 who underwent surgery. The outcome variables were 30-day and 90-day postoperative mortality. We used logistic regression to evaluate mortality between pre-2014 (2010-2013) and post-2014 (2014-2016) time periods for states which did expand (“expansion states”) and did not expand (“non-expansion states”) Medicaid in January 2014. We further used a quasi-experimental DID logistic regression to compare postoperative mortality after 2014 between expansion and non-expansion states. Our main regression models adjusted for cancer stage, age, race, ethnicity, comorbidity score, health insurance, geographic location, income, education, and urban-rural location. Subgroup analyses were unadjusted, odds ratios (ORs) were reported for logistic regression models, and DID ORs were reported for difference-in-difference analyses. Results: Among 169,731 women, 30-day postoperative mortality improved for endometrial cancer in expansion compared to nonexpansion states after 2014 (DID OR: 0.54, 95% CI: 0.31-0.96) on adjusted regression. There was no significant DID change in 30-day postoperative mortality for ovarian and cervical cancer between expansion and non-expansion states. However, the 30-day postoperative mortality in expansion states after 2014 significantly decreased for endometrial cancer (OR: 0.42, 95% CI: 0.26-0.67) and ovarian cancer (OR: 0.67, 95% CI: 0.46-0.99) and significantly increased for cervical cancer (OR: 3.82, 95% CI: 1.12-13.01). Univariable subgroup analysis demonstrated improved 30-day postoperative mortality for Black women with endometrial cancer in expansion compared to non-expansion states after 2014 (DID OR: 0.22, 95% CI: 0.05-0.95). There were no significant DID changes in 90-day postoperative mortality after 2014 based on expansion status for any primary cancer site. However, 90-day postoperative mortality decreased significantly for endometrial (OR: 0.66, 95% CI: 0.50-0.85) cancer in expansion states after 2014. There was improved 90-day postoperative mortality for women with ovarian cancer in the Midwest in expansion compared to non-expansion states after 2014 on univariable subgroup analysis (DID OR: 0.48, 95% CI: 0.26-0.91). Objectives: To compare 30 and 90-day postoperative mortality after surgery for gynecologic malignancy before and after the advent of Medicaid expansion in 2014 in states which did and did not expand Medicaid using a difference-in-difference (DID) analysis. Methods: We included women aged 40-64 years diagnosed with a primary endometrial, ovarian, or cervical malignancy in the National Cancer Database between 2010 and 2016 who underwent surgery. The outcome variables were 30-day and 90-day postoperative mortality. We used logistic regression to evaluate mortality between pre-2014 (2010-2013) and post-2014 (2014-2016) time periods for states which did expand (“expansion states”) and did not expand (“non-expansion states”) Medicaid in January 2014. We further used a quasi-experimental DID logistic regression to compare postoperative mortality after 2014 between expansion and non-expansion states. Our main regression models adjusted for cancer stage, age, race, ethnicity, comorbidity score, health insurance, geographic location, income, education, and urban-rural location. Subgroup analyses were unadjusted, odds ratios (ORs) were reported for logistic regression models, and DID ORs were reported for difference-in-difference analyses. Results: Among 169,731 women, 30-day postoperative mortality improved for endometrial cancer in expansion compared to nonexpansion states after 2014 (DID OR: 0.54, 95% CI: 0.31-0.96) on adjusted regression. There was no significant DID change in 30-day postoperative mortality for ovarian and cervical cancer between expansion and non-expansion states. However, the 30-day postoperative mortality in expansion states after 2014 significantly decreased for endometrial cancer (OR: 0.42, 95% CI: 0.26-0.67) and ovarian cancer (OR: 0.67, 95% CI: 0.46-0.99) and significantly increased for cervical cancer (OR: 3.82, 95% CI: 1.12-13.01). Univariable subgroup analysis demonstrated improved 30-day postoperative mortality for Black women with endometrial cancer in expansion compared to non-expansion states after 2014 (DID OR: 0.22, 95% CI: 0.05-0.95). There were no significant DID changes in 90-day postoperative mortality after 2014 based on expansion status for any primary cancer site. However, 90-day postoperative mortality decreased significantly for endometrial (OR: 0.66, 95% CI: 0.50-0.85) cancer in expansion states after 2014. There was improved 90-day postoperative mortality for women with ovarian cancer in the Midwest in expansion compared to non-expansion states after 2014 on univariable subgroup analysis (DID OR: 0.48, 95% CI: 0.26-0.91).