The 2014 Medicaid expansion under the Affordable Care Act (ACA) is connected with improvements in insurance and early-stage diagnosis among individuals with gynecologic cancer, but its relationship with mortality is uncertain. For a study, researchers sought to determine if the ACA’s Medicaid expansion was connected with increased survival among ovarian cancer patients.
In the retrospective cohort study of patients with newly diagnosed ovarian cancer, they used a difference-in-difference analysis to compare 1-year survival before and after 2014 Medicaid expansion in patients aged 40–64 years in Medicaid expansion states (intervention group) to patients aged 40–64 years in non–Medicaid expansion states. The results were corrected by age, comorbidities, therapy in an academic facility, and Medicaid insurance status factors (race, income, high-school education, distance traveled for care, & living in a rural area).
The study comprised 19,558 ovarian cancer patients, including 9,013 from Medicaid expansion states and 10,545 from non-expansion states. The ACA’s Medicaid expansion was related to higher one-year survival in expansion states compared to non-expansion states (adjusted difference-in-difference 2.2%, 95% CI 0.4–4.1). The mortality difference between expansion and non-expansion states was no longer visible after adding stage at diagnosis. Medicaid expansion was linked to a substantial increase in 1-year survival for White patients (2.4%, 95% CI 0.4–4.4), but not for Black patients (1.3%, 95% CI 5.7 to 8.2) or rural patients (9.5%, 95% CI 8.0 to 26.9).
The ACA’s Medicaid expansion was linked to better one-year survival rates in women with ovarian cancer, which was mediated by an earlier stage at diagnosis. Continued insurance expansion to non-expansion states may increase ovarian cancer survival and lessen inequities.