The Impact of Medicaid Expansion on Stage at Diagnosis of Melanoma Patients: A Retrospective Study.

Simple Summary: The Affordable Care Act's Medicaid expansion aimed to increase healthcare access for low-income individuals by providing Medicaid coverage to more non-elderly adults. This study examines the impact of Medicaid expansion on melanoma diagnosis, treatment, and outcomes, focusing on whether the expansion has led to earlier tumor detection and improved survival rates. By analyzing data from the National Cancer Database, the study reveals that Medicaid expansion is associated with earlier melanoma diagnosis and a decrease in advanced-stage melanoma cases. These findings highlight the importance of public health policies in reducing health disparities and improving cancer care for vulnerable populations. Background: This study addresses the lack of research on Medicaid expansion's impact on melanoma staging, treatment utilization, and outcomes by evaluating its effects under the Affordable Care Act (ACA), particularly focusing on staging at diagnosis, treatment use, and 3-year mortality outcomes. The objective is to determine whether Medicaid expansion led to earlier melanoma diagnosis and improved survival rates among non-elderly adults (ages 40–64) by analyzing data from the National Cancer Database (NCDB). Methods: A total of 12,667 patients, aged 40–64, diagnosed with melanoma from 2010 to 2020 were identified using the NCDB. Difference-in-difference (DID) analysis was performed to analyze tumor staging at presentation between Medicaid expansion states and non-Medicaid expansion states both prior to the expansion and after the expansion. Results: Of the total patients, 2307 were from the pre-expansion time period residing in Medicaid expansion states (MES) and 1804 in non-Medicaid expansion states. In the post-expansion time period there were 5571 residing in the MES and 2985 in the non-MES. DID analysis revealed a decrease in stage IV melanoma at diagnosis (DID −0.222, p < 0.001) between MES and non-MES before and after Medicaid expansion. After expansion, in stage IV, the occurrence of primary surgery was 0.42 in non-MES and 0.44 (difference 0.02); DID analysis was not statistically significant. The use of immunotherapy in MES was significantly higher than in non-MES after expansion (p < 0.001), although DID analysis did not reveal a statistically significant difference. DID analysis showed a statistically significant decrease in 3-year mortality (DID −0.05, p = 0.001) between MES and non-MES before and after Medicaid expansion. Conclusions: This study revealed the positive impact of the ACA's Medicaid expansion on melanoma stage at presentation, highlighting the importance of public health policies in reducing disparities in mortality rates and early-stage diagnoses. Future research should explore additional barriers to care and evaluate the long-term outcomes of Medicaid expansion to optimize cancer care for vulnerable populations. [ABSTRACT FROM AUTHOR]