Improvement in Breast Reconstruction Disparities following Medicaid Expansion under the Affordable Care Act

Abstract

Background: Under the Affordable Care Act, Medicaid expansion effective 1 January 2014 aimed to increase access to health care. We sought to determine the association of Medicaid expansion with disparities in utilization of breast reconstruction. Methods: Non-Hispanic Black (NHB) and White (NHW) breast cancer patients undergoing mastectomy +/− reconstruction between 2010 and 2017 were selected from the National Cancer Database. Annual trends for utilization of breast reconstruction by race, income, and education were evaluated by Medicaid expansion status using difference-in-differences regression analyses. Medicaid expansion was categorized by expansion date as early (2010–2013), 2014 (1/2014), late (after 1/2014), or no expansion. Results: Of 443,607 patients, 36.3% (n = 161,128) underwent reconstruction, 13.1% (n = 58,249) were NHB, 16.8% (n = 74,430) had median income