The Impact of Medicaid Expansion on Head and Neck Malignancies Presentation and Survival

Abstract

Objective: Under the Affordable Care Act (ACA), Medicaid expansion became effective in states that have adopted it. We aim to examine its impact on head and neck cancers. Methods: A retrospective study that utilizes the Surveillance, Epidemiology, and End Results database, 2010–2016. Study population included patients with head and neck squamous cell carcinoma (HNSCC), differentiated thyroid carcinoma, and head and neck cutaneous melanoma. The objective is to examine disease-specific survival before and after Medicaid expansion. Results: In states that adopted Medicaid expansion, the ratio of Medicaid: uninsured patients increased from 3:1 to 9:1 (p < 0.001). In states that did not adopt Medicaid expansion, the ratio increased from 1:1 to 2:1 (p < 0.001), making the increase in Medicaid coverage in states that adopted the expansion significantly higher (p < 0.001). Patients diagnosed with HNSCC before the expansion had worse survival (hazard ratio [HR]: 1.24, 95% confidence interval: 1.11, 1.39, p < 0.001) in states that adopted Medicaid expansion. Conclusions: Early data indicate that implementation of ACA improved disease-specific survival of patients with HNSCC. Level of Evidence: 3 Laryngoscope, 133:1409–1414, 2023.