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Impact of the Affordable Care Act (ACA) Medicaid Expansion on Cancer Admissions and Surgeries

Eguia, Emanuel MD*,†; Cobb, Adrienne N. MD*,†; Kothari, Anai N. MD; Molefe, Ayrin PhD; Afshar, Majid MD§; Aranha, Gerard V. MD; Kuo, Paul C. MD, MS, MBA||

doi: 10.1097/SLA.0000000000002952

Objective: This study aims to evaluate the trends in cancer (CA) admissions and surgeries after the Affordable Care Act (ACA) Medicaid expansion.

Methods: This is a retrospective study using HCUP-SID analyzing inpatient CA (pancreas, esophagus, lung, bladder, breast, colorectal, prostate, and gastric) admissions and surgeries pre- (2010–2013) and post- (2014) Medicaid expansion. Surgery was defined as observed resection rate per 100 cancer admissions. Nonexpansion (FL) and expansion states (IA, MD, and NY) were compared. A generalized linear model with a Poisson distribution and logistic regression was used with incidence rate ratios (IRR) and difference-in-differences (DID).

Results: There were 317, 858 patients in our sample which included those with private insurance, Medicaid, or no insurance. Pancreas, breast, colorectal, prostate, and gastric CA admissions significantly increased in expansion states but decreased in nonexpansion states. (IRR 1.12, 1.14, 1.11, 1.34, 1.23; P < .05) Lung and colorectal CA surgeries (IRR 1.30, 1.25; P < .05) increased, while breast CA surgeries (IRR 1.25; P < .05) decreased less in expansion states. Government subsidized, or self-pay patients had greater odds of undergoing lung, bladder, and colorectal CA surgery (OR 0.45 vs 0.33; 0.60 vs 0.48; 0.47 vs 0.39; P < .05) in expansion states after reform.

Conclusions: In states that expanded Medicaid coverage under the ACA, the rate of surgeries for colorectal and lung CA increased significantly, while breast CA surgeries decreased less. Parenthetically, these cancers are subject to population screening programs. We conclude that expanding insurance coverage results in enhanced access to cancer surgery.

*Department of Surgery, Loyola University Medical Center, Maywood, IL

One: MAP Division of Clinical Informatics and Analytics, Department of Surgery, Loyola University Medical Center, Maywood, IL

Clinical Research Office, Loyola University Chicago, Maywood, IL

§Department of Public Health Sciences, Loyola University Chicago, Maywood, IL

Division of Surgical Oncology, Department of Surgery, Loyola University Medical Center, Maywood, IL

||Department of Surgery, University of South Florida, Tampa, FL.

Reprints: Paul C. Kuo, MD, MS, MBA, Professor and Chair, USF Department of Surgery, Professor, USF Muma College of Business, Richard G. Connar Endowed Chair in Surgery, Surgeon in Chief, Tampa General Hospital, 2 Tampa General Circle, Rm 7015, Tampa, FL 33606. E-mail:

This work is supported by the National Institute of Health 5 T32 GM008750-18.

Meeting Presentation: Will be presented as an oral presentation at the 138th American Surgical Association, April 20, 2018.

The authors report no conflicts of interest.

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