Loehrer Andrew P, Wang Qianfei, O'Malley A James, Wong Sandra L, Tosteson Anna N A
Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
Ann Surg Oncol. 2025 Apr 4. doi: 10.1245/s10434-025-17266-0.
The 2010 Affordable Care Act increased access to colon cancer care for millions of non-elderly adults; however, the direct and indirect impact of Medicaid expansion on Medicare beneficiaries with cancer remains less clear, especially for elderly beneficiaries in rural communities.
Medicare Provider Analysis and Review file was queried for all fee-for-service (FFS) beneficiaries undergoing cancer-directed surgery for colon cancer between 2012 and 2019. Our primary outcomes included 90-day postoperative morbidity, mortality, return to an emergency department, or readmission in the form of an inpatient hospitalization. Multivariable hierarchical logistic regression analyses akin to a difference-in-difference model were performed, allowing the intervention units (US states) to undergo expansion at different times while also controlling for demographic, clinical, and residential geospatial characteristics. Secondary analyses examined for an interaction between rurality and expansion.
Final analysis included 221,814 Medicare beneficiaries who underwent colon cancer-directed surgery between 2012 and 2019. Overall, 141,159 (63.6%) beneficiaries resided in states that adopted expanded Medicaid eligibility. Controlling for confounding factors, Medicaid expansion was not associated with postoperative surgical outcomes, including 90-day morbidity (p = 0.56), mortality (p = 0.30), presentation to an emergency department (p = 0.79), or readmission to an inpatient hospital (p = 0.43). Similarly, analyses evaluating differential association of expansion on rural beneficiaries found no significant differences associated with Medicaid expansion for rural compared with metropolitan beneficiaries.
In these analyses of over 200,000 Medicare beneficiaries across the United States, we found that Medicaid expansion was not associated with any changes in postoperative outcomes for Medicare beneficiaries undergoing colon cancer-directed surgery, either overall or by rural place of residence.
2010年的《平价医疗法案》使数百万非老年成年人更容易获得结肠癌护理；然而，医疗补助扩大对患有癌症的医疗保险受益人的直接和间接影响仍不太明确，尤其是农村社区的老年受益人。
查询医疗保险提供者分析与审查文件，以获取2012年至2019年间所有接受结肠癌定向手术的按服务收费（FFS）受益人。我们的主要结局包括术后90天的发病率、死亡率、返回急诊科或再次住院（以住院治疗的形式）。进行了类似于差异模型的多变量分层逻辑回归分析，允许干预单位（美国各州）在不同时间进行扩大，同时控制人口统计学、临床和居住地理空间特征。二次分析检查了农村地区与扩大之间的相互作用。
最终分析纳入了2012年至2019年间接受结肠癌定向手术的221,814名医疗保险受益人。总体而言，141,159名（63.6%）受益人居住在采用扩大医疗补助资格的州。在控制混杂因素后，医疗补助扩大与术后手术结局无关，包括90天发病率（p = 0.56）、死亡率（p = 0.30）、前往急诊科（p = 0.79）或再次住院（p = 0.43）。同样，评估扩大对农村受益人的差异关联的分析发现，与大城市受益人相比，农村受益人在医疗补助扩大方面没有显著差异。
在对美国超过20万名医疗保险受益人的这些分析中，我们发现医疗补助扩大与接受结肠癌定向手术的医疗保险受益人术后结局的任何变化均无关，无论是总体还是按农村居住地划分。
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