Impact of the affordable care act's medicaid expansion on presentation stage and perioperative outcomes of colorectal cancer.

ABSTRACT

BACKGROUND AND OBJECTIVES: Medicaid expansion has improved healthcare coverage and preventive health service use. To what extent this has resulted in earlier stage colorectal cancer diagnoses and impacted perioperative outcomes is unclear. METHODS: This was a retrospective difference-in-difference study using the National Cancer Database on adults (40-64) with Medicaid or no insurance, diagnosed with colorectal adenocarcinomas before (2010-2013) and after (2015-2018) expansion. The primary outcome was early-stage (American Joint Committee on Cancer Stage 0-1) diagnosis. The secondary outcomes were rate of local excision, emergency surgery, postoperative length of stay, rates of minimally invasive surgery, postoperative mortality, and overall survival (OS). RESULTS: Medicaid expansion was associated with an increase in early-stage diagnoses for patients with colorectal cancers (odds ratio [OR] 1.28, 95% confidence interval [CI] 1.15-1.43), an increase in local excision (OR 1.39, 95% CI 1.13-1.69), and a decreased rate of emergent surgery (OR 0.85, 95% CI 0.75-0.97) and 90-day mortality (OR 0.75, 95% CI 0.59-0.97). Additionally, patients in expansion states postexpansion had an improved 5-year OS (hazard ratio 0.88, 95% CI 0.83-0.94). CONCLUSIONS: Insurance coverage expansion may be particularly important for optimizing stage of diagnosis, subsequent survival, and perioperative outcomes for socioeconomically vulnerable patients.