A Retrospective Study of Lung/Bronchus Cancer Mortality Rates Before and After Enactment of the Affordable Care Act in Mississippi and New York

IntroductionThe Affordable Care Act (ACA), whose major provisions were Medicaid expansion, state insurance exchanges, and allowing dependents to remain on their parents insurance until age 26, was implemented fully in 2014. Increased access to care might have improved access to lung/bronchus cancer diagnosis, treatment, and outcomes. We hypothesized differential changes in lung/bronchus mortality among Mississippi (which did not expand Medicaid) and New York (that did expand Medicaid). MethodsWe utilized the CDC Wonder database to compare lung/bronchus cancer mortality rates in Mississippi, New York, and the United States as a whole, comparing such rates 5 years prior (2009-2013) to 5 years after (2015-2019) ACA enactment. Statistical significance was deemed at p <0.05. ResultsIn the 5 years prior to ACA implementation (2009-2013), there was no statistically-significant difference between Mississippi, New York, or the total U.S. in the percent of population dying from lung/bronchus cancer (p >0.7). In the 5 years following ACA implementation (2015-2019), there was a statistically-significant decrease between Mississippi, New York, and the total U.S. in the percent of population dying from lung/bronchus cancer (p <0.002). Comparing the years 2009-2013 (5 years prior to ACA) and the years 2015-2019 (5 years after ACA), there was a statistically-significant difference in the decrease in percent of population dying from lung and bronchus cancers in New York, Mississippi, and the total United States (p <0.002), with New York having the greatest percent decline. In New York, the percentage of mortalities from lung and bronchus cancers decreased from 0.004691% to 0.004088% (p <0.0001). In Mississippi, the percentage of mortalities from lung and bronchus cancers decreased from 0.006537% to 0.006282% (p = 0.0061). In the total US, the percentage of mortalities from lung and bronchus cancers decreased from 0.05097% to 0.0473% (p <0.0001). ConclusionState-level participation in the ACAs Medicaid expansion was associated with disproportionate improvement in lung/bronchus mortality compared with non-participation and with the U.S. in total.