Association of Medicaid expansion with racial disparities in cancer stage at presentation

BACKGROUND This study evaluates the independent association of Medicaid expansion on stage of presentation among patients of Black and White race with colorectal (CRC), breast, or non‐small cell lung cancer (NSCLC). METHODS A cohort study of patients with CRC, breast cancer, or NSCLC (2009–2017) in the National Cancer Database was performed. Difference‐in‐differences (DID) analysis was used to compare changes in tumor stage at diagnosis between Medicaid expansion (MES) and non‐expansion states (non‐MES) before and after expansion. Predictive margins were calculated by race, year, and insurance status to account for effect heterogeneity. Stage migration was determined by measuring the combined proportional increase in stage I and decrease in stage IV disease at diagnosis. RESULTS Black patients gained less Medicaid coverage than White patients (6.0% vs 13.1%, p