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The Early Impact of Medicaid Expansion in Urologic Malignancies in the United States


(UroToday.com) Medicaid expansion was a core tenet of the Affordable Care Act (ACA), aimed at increasing coverage for low-income individuals. Medicaid expansion was undertaken at a state-level with some opting in and others electing not to participate. In a session of the Best Poster Presentations in Health Services and Other Research at this year’s Society of Urologic Oncology (SUO) virtual annual meeting, Dr. Meng presented an analysis evaluating whether improved insurance coverage through Medicaid expansion is associated with earlier detection and improved survival for patients with urologic cancers.


To do so, the authors utilized the National Cancer Database to identify patients aged 18 to 64 years with bladder, prostate, kidney, and testis cancers (the four most common urologic malignancies) diagnosed between 2011 and 2016, to encompass the period of main Medicaid expansion in January 2014. The authors utilized a difference-in-difference design to estimate the effect of Medicaid expansion on the proportion of uninsured patients, Medicaid-enrolled patients, early-stage diagnoses (defined as Stage 1), and late-stage diagnoses (defined as Stage 4). The authors examined each tumor site separately and analyses were adjusted for the effect of age, race/ethnicity, rurality, education, income, Charlson-Deyo comorbidity index, and hospital facility type using propensity scores.

As would be expected based on the use of the NCDB, most patients were non-Hispanic white and privately insured.


Following the implementation of the Affordable Care Act and Medicaid expansion, the proportion of patients with Medicaid coverage at the time of diagnosis increased significantly among states with Medicaid expansion, with the most pronounced effect among patients with kidney and testis cancer. Concurrently, there was an associated decrease in uninsured patients in Medicaid expansion states among those diagnosed with testis cancer but not those with bladder, kidney, or prostate cancer.


The authors found no differences in stage at the presentation following Medicaid expansion in affected states.


They concluded that, though Medicaid expansion was associated with better insurance coverage for patients with kidney, testis, bladder, and prostate cancer, this did not affect stage at presentation. Perhaps not surprisingly, effects were greatest among patients with testis cancer given their younger age at diagnosis.


Presented by: Xiaosong Meng, MD, Ph.D., Assistant Instructor, Department Urology, UT Southwestern Medical Center, Frisco, Texas

Written by: Christopher J.D. Wallis, MD, Ph.D., Instructor in Urology, Vanderbilt University Medical Center, Nashville, Tennessee @WallisCJD on Twitter at the 2020 Society of Urologic Oncology Annual Meeting – December 2-5, 2020 – Washington, DC


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