{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T23:06:24Z","timestamp":1792451184414,"version":"4.5.0"},"reference-count":43,"publisher":"Wiley","issue":"13","license":[{"start":{"date-parts":[[2024,7,6]],"date-time":"2024-07-06T00:00:00Z","timestamp":1720224000000},"content-version":"vor","delay-in-days":5,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004917","name":"Cancer Prevention and Research Institute of Texas","doi-asserted-by":"publisher","award":["RP 170259"],"award-info":[{"award-number":["RP 170259"]}],"id":[{"id":"10.13039\/100004917","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["T32CA101642"],"award-info":[{"award-number":["T32CA101642"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The Affordable Care Act expanded Medicaid coverage for people with low income in the United States. Expanded insurance coverage could promote more timely access to cancer treatment, which could improve overall survival (OS), yet the long\u2010term effects of Medicaid expansion (ME) remain unknown. We evaluated whether ME was associated with improved timely treatment initiation (TTI) and 3\u2010year OS among patients with breast, cervical, colon, and lung cancers who were affected by the policy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Medicaid\u2010insured or uninsured patients aged 40\u201364 with stage I\u2013III breast, cervical, colon, or non\u2010small cell lung cancer within the National Cancer Database (NCDB). A difference\u2010in\u2010differences (DID) approach was used to compare changes in TTI (within 60\u2009days) and 3\u2010year OS between patients in ME states versus nonexpansion (NE) states before (2010\u20132013) and after (2015\u20132018) ME. Adjusted DID estimates for TTI and 3\u2010year OS were calculated using multivariable linear regression and Cox proportional hazards regression models, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      ME was associated with a relative increase in TTI within 60\u2009days for breast (DID\u2009=\u20094.6;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), cervical (DID\u2009=\u20095.0\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.013), and colon (DID\u2009=\u20094.0,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.008), but not lung cancer (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.505). In Cox regression analysis, ME was associated with improved 3\u2010year OS for breast (DID hazard ratio [HR]\u2009=\u20090.82,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.009), cervical (DID\u2010HR\u2009=\u20090.81,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.048), and lung (DID\u2010HR\u2009=\u20090.87,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003). Changes in 3\u2010year OS for colon cancer were not statistically different between ME and NE states (DID\u2010HR, 0.77;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.075).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Findings suggest that expanded insurance coverage can improve treatment and survival outcomes among low income and uninsured patients with cancer. As the debate surrounding ME continues nationwide, our findings serve as valuable insights to inform the development of policies aimed at fostering accessible and affordable healthcare for all.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cam4.7461","type":"journal-article","created":{"date-parts":[[2024,7,6]],"date-time":"2024-07-06T03:23:16Z","timestamp":1720236196000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Effect of Medicaid expansion on cancer treatment and survival among Medicaid beneficiaries and the uninsured"],"prefix":"10.1002","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6433-4195","authenticated-orcid":false,"given":"Kristin M.","family":"Primm","sequence":"first","affiliation":[{"name":"Department of Epidemiology The University of Texas MD Anderson Cancer Center  Houston Texas USA"},{"name":"Department of Epidemiology and Biostatistics The University of California San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4742-1139","authenticated-orcid":false,"given":"Hui","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Health Services Research The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naomi N.","family":"Adjei","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology and Reproductive Medicine The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte C.","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology and Reproductive Medicine The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alen","family":"Haas","sequence":"additional","affiliation":[{"name":"Department of Health Services Research The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Larissa A.","family":"Meyer","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology and Reproductive Medicine The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shine","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Epidemiology The University of Texas MD Anderson Cancer Center  Houston Texas 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