Nationwide Study Shows Cancer Mortality Benefit Following State Medicaid Expansion


The study is the first of its kind on a national scale to show the benefit of Medicaid expansion on cancer mortality rates.


A nationwide study presented in the 2020 American Society of Clinical Oncology (ASCO) Virtual Scientific Program found that states that expanded Medicaid following the Affordable Care Act (ACA) experienced additional cancer mortality benefit compared with non-expansion states.1

The study, presented in advance of the meeting by lead author Anna Lee, MD, MPH, also evaluated cancer mortality among various populations (black, white, and Hispanic) and found greater change in expansion states than in the non-expansion states.1

“This study provides needed data to understand the effects of Medicaid expansion on cancer care. Better access to quality cancer care, in this case through state expansion of Medicaid, leads to fewer cancer deaths,” said ASCO Chief Medical Officer and Executive Vice President Richard L. Schilsky, MD, FACP, FSCT, FASCO.2

Investigators highlighted that cancer is a health care amenable condition, where having access to health care may improve outcomes. Twenty million Americans were able to get insurance under the ACA, and 27 states including Washington, DC, expanded Medicaid after 2014 under the ACA, whereas 23 states did not expand. The study estimated that 589 deaths could have been prevented if all states had expanded.1

The difference-in-difference analysis of age-adjusted cancer mortality between 1999-2017 showed consistently worse mortality rates in non-expanded states when compared to expanded states. Mortality rates dropped by 29%, from 65.1 to 46.3 per 100,000 in expanded states; non-expansion states showed a 25% decline in cancer mortality, from 69.5 to 52.3 per 100,000 individuals, according to the study.1

The population data, acquired from the National Center for Health Statistics, found that cancer morality decreased over time across all populations. Investigators also reported large disparities across populations, with black populations having the highest overall cancer mortality.1

The authors underlined other population benefits as well. “There is a greater Hispanic population in states that have adopted Medicaid expansion, and they have almost 3 times the un-insurance rate as white adults,” said senior author Fumiko Chino, MD, a radiation oncologist at MSK. “Our research shows that Hispanic patients with cancer may have benefited the most because they had the most to gain.”2


1. Lee A, Shah K, Chino J, et al. Changes in Cancer Mortality Rates After the Adoption of the Affordable Care Act. Presented at: 2020 American Society of Clinical Oncology Virtual Scientific Program; May 29-31; online.
2. Greater Decline in Cancer-Related Deaths Seen in Medicaid Expansion States in First Nationwide Study. News Release. ASCO; May 13, 2020. Accessed May 15, 2020.

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