American Surgical Association

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Impact of the Affordable Care Act (ACA) Medicaid Expansion on Cancer Admissions and Surgeries
Emanuel Eguia*1, Adrienne N. Cobb*1, Anai N. Kothari*1, Haroon Janjua*1, Ayrin Molefe*1, Paul C. Kuo2
1Loyola, Maywood, IL;2USF, Tampa, FL

OBJECTIVE(S): To evaluate the trends in cancer (CA) admissions and surgeries after ACA Medicaid expansion.
METHODS: This is a retrospective study using HCUP-SID analyzing inpatient CA (pancreas, esophagus, lung, bladder, breast, colon, prostate and stomach) admissions and surgeries pre-(2010-2013) and post-(2014) Medicaid expansion. Surgery was defined as observed resection rate per 100 cancer admissions. Non-Expansion (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, 379 patients with private insurance, Medicare, Medicaid or no insurance. Pancreas, breast, colon, prostate, and stomach CA admissions significantly increased in Expansion, but decreased in Non-Expansion states. (IRR=1.12, 1.14, 1.11, 1.34, 1.23, respectively; p<0.05) Lung and colon CA surgeries (IRR=1.30, 1.25; p<0.05) increased, while breast CA surgeries (IRR=1.25; p<0.05) decreased less in Expansion states. Govt. subsidized or self-pay patients had greater odds of undergoing lung, bladder, and colon CA surgery (OR; 0.45 vs. 0.33; 0.60 vs. 0.48; 0.47 vs. 0.39; p<0.05) in Expansion states after reform compared to Non-Expansion.
CONCLUSIONS: In states that expanded Medicaid coverage under the ACA, the rate of surgeries for breast, colon and lung CA increased significantly. Parenthetically, these cancers are subject to population screening programs. We conclude that expanding insurance coverage results in enhanced access to cancer surgery.

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