| Title | Association of medicaid expansion of the Affordable Care Act with the stage at diagnosis and treatment of papillary thyroid cancer: A difference-in-differences analysis. |
| Publication Type | Journal Article |
| Year of Publication | 2021 |
| Authors | Limberg J, Stefanova D, Thiesmeyer JW, Ullmann TM, Bains S, Finnerty BM, Zarnegar R, Li J, Iii TJFahey, Beninato T |
| Journal | Am J Surg |
| Volume | 222 |
| Issue | 3 |
| Pagination | 562-569 |
| Date Published | 2021 Sep |
| ISSN | 1879-1883 |
| Keywords | Adult, Databases, Factual, Female, Humans, Insurance Coverage, Iodine Radioisotopes, Male, Medicaid, Medical Overuse, Medically Uninsured, Middle Aged, Patient Protection and Affordable Care Act, Poverty Areas, Private Sector, Radiotherapy, Adjuvant, Thyroid Cancer, Papillary, Thyroid Neoplasms, United States |
| Abstract | BACKGROUND: The Affordable Care Act's (ACA) Medicaid expansion has increased insurance coverage and improved various cancer outcomes. Its impact in papillary thyroid cancer (PTC) remains unclear. METHODS: Non-elderly patients (40-64 years-old) with PTC living in low-income areas either in a 2014 expansion, or a non-expansion state were identified from the National Cancer Database between 2010 and 2016. Insurance coverage, stage at diagnosis, and RAI administration were analyzed using a difference-in-differences analysis. RESULTS: 10,644 patients were included. Compared with non-expansion states, the percentage of uninsured patients (adjusted-DD -2.6% [95%-CI -4.3to-0.8%],p = 0.004) and patients with private insurance decreased, and those with Medicaid coverage increased (adjusted-DD 9.7% [95%-CI 6.9-12.5%],p < 0.001) in expansion states after ACA implementation. The percentage of patients with pT1 did not differ between expansion and non-expansion states; neither did the use of RAI. CONCLUSIONS: Medicaid expansion has resulted in a smaller uninsured population in PTC patients, but without earlier disease presentation nor change in RAI treatment. |
| DOI | 10.1016/j.amjsurg.2021.01.016 |
| Alternate Journal | Am J Surg |
| PubMed ID | 33541689 |