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.

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From: The American Journal of Surgery(Vol. 222, Issue 3)
Publisher: Elsevier B.V.
Document Type: Report; Brief article
Length: 356 words

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Keywords Medicaid; Affordable care act; Papillary thyroid cancer; Radioactive iodine; Expansion Highlights * The Affordable Care Act's Medicaid expansion has impacted various cancer outcomes. * After expansion fewer patients with papillary thyroid cancer were uninsured. * No earlier presentation of papillary thyroid cancer after Medicaid expansion. * No change in adjuvant radioactive iodine use after Medicaid expansion. * Increased Medicaid coverage alone may not significantly alter thyroid cancer care. 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 Conclusions Medicaid expansion has resulted in a smaller uninsured population in PTC patients, but without earlier disease presentation nor change in RAI treatment. Author Affiliation: (a) Department of Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 525 E 68th St, New York, NY, 10065, USA (b) Department of Healthcare Policy and Research, Weill Cornell Medical College, 1300 York Ave, New York, NY, 10065, USA (c) Department of Surgery, Rutgers--Robert Wood Johnson Medical School, Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08901, USA * Corresponding author. 195 Little Albany Street, New Brunswick, NJ, 08901, USA. Article History: Received 25 August 2020; Revised 5 January 2021; Accepted 9 January 2021 Byline: Jessica Limberg (a), Dessislava Stefanova (a), Jessica W. Thiesmeyer (a), Timothy M. Ullmann (a), Sarina Bains (a), Brendan M. Finnerty (a), Rasa Zarnegar (a), Jing Li (b), Thomas J. Fahey III [tjfahey@med.cornell.edu] (a), Toni Beninato [Toni.beninato@rutgers.edu] (a,c,*)

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Gale Document Number: GALE|A671900167