Study Finds Medicaid Expansion Has Improved Survival for Some Cancer Patients

Patients with cancer in rural or high-poverty areas were associated with the most significant improvements in five-year survival.

In 2014, a provision under the Patient Protection and Affordable Care Act (ACA) took effect, allowing states to expand Medicaid eligibility to adults with incomes up to 138% of the federal poverty guidelines. While studies have established that Medicaid expansion has led to improved two-year survival rates for individuals diagnosed with cancer, longer-term survival has been unknown.

A new study, however, found that Medicaid expansion has appeared to improve both five-year cause-specific and overall survival in cancer patients. The research was published in Cancer Discovery, a journal of the American Association for Cancer Research (AACR).

“Studying the impact of Medicaid expansion on longer-term survival outcomes among individuals diagnosed with cancer is important for guiding evidence-based decision-making by policymakers and advocates for maintaining and expanding Medicaid,” explained Elizabeth Schafer, MPH, an associate scientist at the American Cancer Society and the lead author of the study.

Quasi-experimental Design: Treating Medicaid Expansion Like a Drug

Dr. Schafer and her coauthors designed the study using the difference-in-differences (DD) method, which allowed them to treat Medicaid expansion as an experimental intervention, with effects that could be measured against a control group of states that had not enacted the expansion.

The study analyzed data from 1,423,983 cancer cases diagnosed in adults aged 18 to 59 years and compared five-year survival rates from follow-up data obtained in the years following a cohort from 2007-2008 (a period prior to Medicaid expansion) and 2014-2015 (a period when many states had adopted the expansion). The analysis assessed and compared 26 expansion states with 12 states that did not expand Medicaid at that time.

Expanded Medicaid and Expanded Survival

Researchers observed that Medicaid expansion was associated with significant improvements in cause-specific and overall survival for cancer patients living in rural areas and high-poverty areas. Patients with cancers associated with higher mortality also experienced notable progress in both cause-specific and overall survival if they lived in Medicaid expansion states. Overall survival among non-Hispanic Black individuals was also substantially higher in Medicaid expansion states. Further, expansion was associated with considerable increases in both cause-specific and overall survival in non-Hispanic Whites as well.

Medicaid Expansion’s Effectiveness as a Public Health Policy

As of October 2025, 40 out of 50 states and the District of Columbia have enacted the expansion, but 10 (Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming) have not.

“Research has shown that Medicaid expansion can increase cancer screening prevalence, early-stage diagnosis, short-term survival, and now—according to our own analysis—five-year survival. These findings underscore the importance of expanding Medicaid in the 10 remaining nonexpansion states and protecting expansion in the states that have already implemented it in order to improve outcomes for all individuals,” Dr. Schafer said.

The bottom line, according to Dr. Schafer: “The evidence supporting Medicaid expansion in improving outcomes for individuals diagnosed with cancer is clear.”