Medicaid Expansion May Decrease Early Mortality in Some With NSCLC

Early mortality from NSCLC after surgery has decreased in U.S. states with Medicaid expansion, research showed.

A decrease in early mortality from non-small cell lung cancer (NSCLC) has been shown in states that have Medicaid expansion, a study from JAMA Network Open established.

Particularly, research from the study concluded that states with Medicaid expansion demonstrated notable decreases in 30-day and 90-day postoperative (after surgery) mortality in patients with stages 1, 2 or 3 NSCLC, according to the study.

The study included 14,984 patients who underwent surgery for NSCLC, with an average age of 56.3 years. There were 54.6% of patients who identified as women, 45.4% who identified as men and the majority of patients identified as non-Hispanic Black (19.1%) or non-Hispanic White (69.2%).

Of note, 62.1% of patients lived in a state that supported Medicaid expansion. The researchers determined that compared with patients who lived in expansion states, patients who lived in non-Medicaid expansion states when they received a diagnosis were found to be younger, identified as non-Hispanic Black, uninsured, had stage 2 NSCLC and had comorbidities.

“Lung cancer is the second most commonly diagnosed cancer in the U.S. and the leading cause of cancer-related mortality, but Medicaid expansion can help improve access to lifesaving care,” Dr. Leticia Nogueira, scientific director, health services research at the American Cancer Society and lead author of the study, said in a news release from the American Cancer Society. “This study quantifies the impact of Medicaid expansion on survival among vulnerable patient populations, demonstrating the importance of health care coverage and access to timely care.”

A significant evaluation in the study included identifying some differences in early mortality in the patient population after receiving surgery for NSCLC prior to and after the Affordable Care Act (ACA) was implemented. The researchers also analyzed differences between U.S. states that expanded Medicaid and states that did not.

In specific, the 30-day mortality rate after receiving surgery decreased from 0.97% before the ACA was implemented to 0.26% after the ACA in states that supported Medicaid expansion, the researchers found.

The data from the study regarding non-expansion states reflected that there was no significant change in percentages: 0.75% before the ACA and 0.68% after the ACA. This meant that the 30-day mortality rates after receiving surgery did not decrease by much.

In Medicaid expansion states, the 90-day mortality rates after surgery for NSCLC decreased from 2.63% before the ACA to 1.32% after the ACA, the study noted. Similar to the study’s data from the 30-day mortality rates for non-expansion states, the 90-day postoperative mortality reflected 2.43% before the ACA and 2.20% after the ACA.

“This study is further proof that expanding Medicaid saves lives,” Lisa Lacasse, president of American Cancer Society Cancer Action Network, said in the news release. “We know what we need to do to end cancer as we know it for everyone, most critically of which is that people with cancer have access to the care they need — including the crucial types of post-operative care this study analyzes. Medicaid expansion helps ensure more people have that access and a better chance of surviving cancer, which is why ACS CAN has long advocated for this evidence-based policy. ACS CAN continues to urge the 10 states who have yet to increase Medicaid eligibility to expand access quickly. Lives are at stake.”

“Especially after a major procedure like lung cancer surgery, it’s crucial that people have access to timely care,” Nogueira added. “As policymakers consider whether to expand or update Medicaid, our study details how coverage leads to positive health outcomes.”

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