Impact and Durability of the Affordable Care Act Medicaid Expansion on Lung Cancer Treatment.

Background: Medicaid expansion began in 2014 after passage of the Affordable Care Act; however, the impact and durability of the effects on lung cancer treatment utilization are poorly defined. We aimed to determine whether there is a persistent difference in utilization of lung resection, lung biopsy, and nonoperative treatment of lung cancer in states participating in Medicaid expansion compared with states that are not.

Methods: A retrospective cohort study was completed analyzing the difference in utilization between Medicaid expansion states and non-expansion states in 2012-2013, 2016-2017, and 2019. Patients diagnosed with and treated for lung cancer in the states of North Carolina and Florida (non-expansion states) and Maryland and New Jersey (expansion states) were included. A difference-in-difference (DID) analysis was used.

Results: In the immediate postexpansion period (2016-2017), DID analysis revealed increased utilization in expansion states with an adjusted DID of 0.50 lung resections/100,000 persons ( = .002) and an adjusted DID of 0.76 lung biopsies/100,000 persons ( = .001). A persistent increase in utilization was found in the delayed postexpansion period (2019), with an adjusted DID of 0.51 lung resections/100,000 persons ( = .008) and an adjusted DID of 0.84 lung biopsies/100,000 persons ( = .021). No significant difference between groups was observed in the utilization of stereotactic body radiation therapy or chemotherapy.

Conclusions: In our cohort, Medicaid expansion was associated with increased utilization of procedural care for the management of lung cancer, including percutaneous biopsies and surgical resection.