Medicaid Expansion Linked to Improved Access to Local Therapy for Early-Stage Lung Cancer
A recent retrospective study using the National Cancer Database suggests that Medicaid expansion under the Affordable Care Act (ACA) may improve access to local therapy—surgery or stereotactic body radiation therapy (SBRT)—for patients with early-stage non-small cell lung cancer (NSCLC), particularly among Medicaid beneficiaries.
The study analyzed data from 149 966 patients with clinical stage T1-2, N0, M0 NSCLC who did not receive neoadjuvant treatment. Researchers compared treatment patterns in Medicaid expansion states and non-expansion states across 2 time periods: pre-expansion (2010–2013) and post-expansion (2016–2019). A difference-in-difference (DID) analysis was used to evaluate changes in the receipt of local therapy.
While receipt of local therapy and surgery declined across the board during the study period, the decline was less pronounced in Medicaid expansion states. The receipt of local therapy decreased by 1.6% in expansion states compared with 2.8% in non-expansion states (DID 1.24%; 95% CI, 0.45–2.02%), and the receipt of surgery decreased by 7.9% vs 9.3%, respectively (DID 1.4%; 95% CI, 0.46–2.4%).
Among Medicaid beneficiaries specifically, access to local therapy improved significantly more in expansion states. The proportion of patients receiving either surgery or SBRT increased by 18.9% in expansion states compared with just 1.1% in non-expansion states (DID 7.8%; 95% CI, 6.12–9.4%). Similarly, the rate of surgery alone rose by 8.1% vs 0.12% (DID 8.0%; 95% CI, 6.3–9.66%).
Additionally, patient travel burdens were reduced in expansion states. The proportion of patients traveling more than 10 miles for care declined by 3.7% in expansion states compared with 5.1% in non-expansion states (DID –1.5%; 95% CI, –2.46 to –0.35%).
These findings underscore the potential of Medicaid expansion to enhance timely access to first-line treatment for early-stage lung cancer, reduce geographic barriers to care, and support improved outcomes for a historically underserved population. This study adds to the growing body of evidence linking insurance coverage expansion with greater treatment equity and health care delivery efficiency in oncology.
Reference
Madeka I, Mack SJ, Rshaidat H, et al. Medicaid expansion is associated with differences in local therapy for non-small cell lung cancer. Ann Surg Oncol. 2025;32(6):3913-3923. doi:10.1245/s10434-025-17082-6
