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

Abstract

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.

Keywords: Medicaid expansion; cancer patients.

Figure 1

Current Status of Medicaid expansion among the US states as of April 2023: Data Derived from the Kaiser Family Foundation [11].

Figure 2

Significant improvements in the 2-year overall survival rates among specific sociodemographic groups of newly diagnosed cancer patients following Medicaid expansion. DD (for Ji et al. [57], Barnes et al. [56], and Han et al. [48]) and their 95% confidence intervals are presented for the following: young adults (age 18–39 years); racial and ethnic minoritized groups (including Hispanic, non-Hispanic Black, and other races and ethnicities); patients with middle income as determined by zip code (defined as 139–400% of federal poverty level); pediatric patients (age 0–14 years); patients with lowest quartile county income; patients at <5% below the poverty level; and Non-Hispanic Black patients. DD analyses were used to compare changes in survival in Medicaid expansion states relative to non-expansion states. DD: difference-in-differences; ppt: percentage point.