Medicaid expansion and cancer stage at diagnoses during the COVID-19 pandemic in the United States.

BACKGROUND

Substantial cancer underdiagnosis, especially early-stage cancers, occurred during the COVID-19 pandemic in the United States. Medicaid expansion under the Affordable Care Act could facilitate access to timely detection of cancer during pandemic-related financial and employment instability. This study examines the association of Medicaid expansion and changes in cancer stage at diagnosis during the COVID-19 pandemic.

METHODS

We compared changes in proportions of early-stage (stage I/II) cancer diagnosis in Medicaid expansion states versus non-expansion states among 1 844 515 individuals aged 18-64 years newly diagnosed with cancer in 2018-2022 from the National Cancer Database using a difference-in-differences (DD) approach. Adjusted DD estimates were calculated with linear probability models and stratified by key sociodemographic factors and cancer type.

RESULTS

We found that Medicaid expansion was statistically significantly associated with smaller decreases in proportions of early-stage cancer diagnosis among individuals aged 18-44 years (DD = 1.26; 95% CI = 0.54 to 1.98), men (DD = 0.61; 95% CI = 0.08 to 1.14), and those with high comorbidity burden (Charlson-Deyo comorbidity score ≥ 2; DD = 1.51; 95% CI = 0.24 to 2.78), treated in academic facilities (DD = 0.55; 95% CI = 0.03 to 1.06), or diagnosed with prostate cancer (DD = 1.52; 95% CI = 0.56 to 2.47).

CONCLUSIONS

Our findings suggest a protective effect of Medicaid expansion on early-stage cancer diagnoses during the COVID-19 pandemic and public health emergency in the United States, informing policy makers and the public in the 10 states that have yet to expand Medicaid eligibility. Findings can also inform policy makers and the public in all states about the public health implications of upcoming large federal cuts to Medicaid programs and coverage.