Health Services/Policy
Policy Effect Heterogeneity of the Medicaid Expansion Program on Cancer Mortality Overall and by U.S. Region, Sex and Race/Ethnicity: A Generalized Synthetic Approach Mina Habib* Mina Habib Roch A. Nianogo
Background: Starting in 2014, the Patient Protection and Affordable Care Act aimed to expand Medicaid to cover individuals with incomes up to 138% of the federal poverty level. A Supreme Court ruling allowed states to opt out, creating a natural experiment to study Medicaid expansion’s (ME) impact on cancer mortality. This study evaluated ME’s effects on age-adjusted cancer mortality among individuals aged 25–64, overall and by U.S. region, gender, and race/ethnicity.
Methods: State-level data (2005–2019) from the U.S. Centers for Disease Control and Census Bureau were analyzed using a person-time weighted generalized synthetic control method. We adjusted for demographics, socioeconomic status, and primary care physician density to estimate mean differences (MD) per 100,000 persons per year. Thereafter, we assessed the presence of disparities across subgroups via a difference in Difference-in-Differences (DDD) model, using the group of most benefit as the reference.
Results: ME was associated with a modest overall reduction in cancer mortality (MD: -2.06; 95% CI: -4.24, 0.11). Subgroup analyses revealed significant reductions among women (MD: -3.02; 95% CI: -5.28, -0.77) versus men (MD: -0.59; 95% CI: -3.61, 2.42), with an imprecise DDD of -2.43 (95% CI: -6.19, 1.33). White Americans had the largest decrease (MD: -2.27; 95% CI: -4.15, -0.38) compared to Black (MD: -1.67; 95% CI: -6.19, 2.84) and Hispanic Americans (MD: 1.02; 95% CI: -9.54, 11.58), with imprecise DDDs. States in the Northeast had the largest decrease (MD: -4.46; 95% CI: -7.4, -0.89), followed by the South (MD: -2.59; 95% CI: -5, 0.57), West (MD: -1.03; 95% CI: -4.61, 3.29), and Midwest (MD: -0.71; 95% CI: -3.2, 2.47), all with imprecise DDDs.
Conclusion: ME appears to reduce cancer mortality; however, the impact on other subgroups, including racial minorities and males, remains unclear. Continued research is essential to understand and address these disparities.
