Table 2.

Summary of literature search results evaluating effects of Medicaid expansion for the three key domains of changes in insurance rates, cancer screening and access to care, and socioeconomic disparities.

Citation, Author, Year	Sample	Cancer Type	Sample Size	More Insurance Coverage	More Screening & Treatment	Reduced Socioeconomic Disparities
24. Okoro et al. 2017	BRFSS. 18–64 years old. 2014.	Breast, cervical, colorectal	277,734	Not studied for cancer patients	Yes, greater breast (3ppt), cervical (1.5ppt), and colorectal (2.5ppt) cancer screening	Yes, reduced income gap in breast cancer screening, but not for cervical and colorectal cancer screening
25. Lyu et al. 2019	BRFSS. Low-income adults (<138% FPL). 18–64 years old. 2012 vs. 2016.	Breast, cervical, colorectal	31,890	Not studied.	Yes, greater breast (11.4ppt), cervical (6.9ppt), and colorectal (8.3ppt) cancer screening	Not studied.
26. Mahal et al. 2020	SEER. 18–64 years old. 2010–2014.	Breast, lung, and prostate	108,864	Yes, 71% fewer uninsured in Medicaid expansion states.	Not studied.	Yes, elimination of uninsured gap between Blacks (90.5% decrease) and Whites and between low-income (<138% FPL, 7% decrease) and high income people.
27. Chino et al. 2017	SEER. Radiation recipients. 18–64 years old. 2011–2014.	All Cancer	197,290	Yes, 53% fewer uninsured	Not studied.	Yes, greatest gains among Blacks (50%), high poverty areas (60% fewer uninsured)
28. Jemal et al. 2017	NCDB. 18–64 years old. 2011–2014.	All Cancer	1,718,864	Yes, 54.7% fewer uninsured	No, similar shift to earlier stage	Yes, reduced income gap in uninsured rate (62.5% fewer uninsured at <138%FPL)
29. Moss et al. 2017	SEER. Women. <65 years old. 2008–2014.	Cervical, uterine or ovarian	90,192	Yes, 50% fewer uninsured	No, shift toward later stage	Yes, reduced Black (by 50%) and low-income uninsured rate (by 72%)
30. Cannon et al. 2018	SEER. 19–64 years old. 2007–2014.	Head and Neck Squamous Cell Carcinoma	89,038	Yes, 52% fewer uninsured, 9.5% more via Medicaid	Not studied.	Not studied.
31. Crocker et al. 2018	HCUP-SID (Florida, Kentucky, Maryland, New Jersey, North Carolina). Cancer surgery patients. 18–64 years old. 2012–2015.	Colorectal, esophagogastric, hepatobiliary, lung, and urologic	78,915	Yes, 13.4% fewer uninsured	Yes, 4.1% increase in non-discretionary cancer surgeries (5.3% decrease in non-expansion states)	Not studied.
32. Eguia et al. 2018	HCUP-SID (Florida, Iowa, Maryland, New York). 18–64 years old. 2010–2014.	Pancreas, esophagus, prostate, bladder, colorectal, lung, and gastric	317,858	Yes, Medicaid insured increased: 12% for pancreatic, 14% for breast, 11% for colorectal, 34% for prostate, and 23% for gastric cancers (Expansion vs. non-expansion states)	Yes, cancer surgery rates up 30% for lung cancer, 25% for breast cancer, 25% for colorectal cancer in Medicaid Expansion states compared to non-expansion states	Yes, disparities in odds to undergo surgery between Medicaid and privately insured cancer patients of Black race and Hispanic race decreased after Medicaid expansion and increased in non-expansion states
33. Han et al. 2018	NAACCR (40 states). First primary malignant cancer. 18–64 years old. 2010–2014.	All Cancer	2,471,154	Yes, 50% fewer uninsured	Yes, 2.3% greater early-stage diagnosis: all cancers combined	Yes, reduced insurance disparities based on race (for Blacks and Hispanics), income, and rural residence
34. Moss et al. 2018	SEER. 0–64 years old. 2008–2014.	Breast, lung, and colon	414,085	Yes, fewer uninsured, more Medicaid insured: Colon (−50%,+38%) lung (−57%,+24%) breast (−33%,+14%) cancer	Yes, increase in early- stage diagnoses by 1.2% for breast, 6.4% for colon, but no change for lung cancer	Yes, uninsured rates decreased for all races except: American Indians/Alaskan Natives for lung & colon cancer, and except Blacks and American Indians/Alaskan Natives for breast cancer
35. Soni et al. 2018	SEER. First time cancer diagnosis. 19–64 years old. 2010–2014.	All Cancer	3,055	Not studied.	Yes, 6.4% increase in early-stage diagnoses	Not studied.
36. Agarwal et al. 2019	SEER. 0–64 years old. 2011–2015. Compared expansion states against non-expansion states.	All Cancer	716,364	Yes, 3% greater decrease in uninsured in expansion vs. non-expansion states	Not studied.	Yes, greatest decreases in uninsured among rural (−4.8%) & minorities except Asians and Pacific Islanders: Black (−3.4%), Hispanic (−3.9%)
37. Crocker et al. 2019	HCUP-SID (Florida, Kentucky, Maryland, New Jersey, North Carolina). Inpatient cancer surgery patients. 18–64 years old. 2012–2015	Colorectal, esophagogastric, hepatobiliary, pancreatic, lung, urologic	81,628	Yes, 82.6% more insured via Medicaid in expansion states; 10.1% fewer Medicaid-insured in non-expansion states	Yes, 10.8% greater utilization by Medicaid & uninsured patients; 9.5% less in non-expansion states	Mixed Results. Expansion narrowed the income gap but not the race gap (Whites relative to Blacks and Hispanics) in cancer surgery utilization
38. Spiegel et al. 2019	SEER. New diagnosis. 19–64 years old. 2011–2014.	Breast, cervical, uterine, or prostate with brachytherapy	15,497	Yes, 38% fewer uninsured	Not studied.	Mixed Results. Expansion narrowed insurance income gap but not the race gap (Whites relative to Blacks and Hispanics)
39. Huguet et al. 2019	ADVANCE clinical data. Age-based screening cohorts from 21–64 years old. 2012–2015.	Cervical and colorectal	329,126	Yes, Medicaid visit rate up 56%, uninsured visit rate decreased 52% after Medicaid expansion	No, similar screening rates since increased in both states	Yes, narrowed race gap (Whites relative to Blacks and Hispanics) for cervical and colorectal cancer screening
40. Mesquita-Neto et al. 2019	SEER. All patients. 2007–2009 vs. 2014–2015.	Breast, colorectal, ovarian, lung, uterine, pancreatic, prostate, and liver	293,028	Yes, 50% fewer uninsured in Medicaid expansion states	Yes, 12.8% increase in early-stage diagnoses	Yes, 54.5% fewer uninsured & 3.8% greater access to surgery for people of low socioeconomic standing
41. Sineshaw et al. 2020	NCDB. 18–64 years old. 2010–2016.	Head and Neck Squamous Cell Carcinoma	90,789	Yes, 63% decrease in uninsured, 18% increase in Medicaid insured in Medicaid expansion states	Yes, 3.8% increase in early-stage diagnoses. Time to treatment initiation down 5.5 days for nonoropharyngeal head & neck squamous cell carcinoma, no difference for overall head & neck squamous cell carcinoma	Not studied.
42. Takvorian et al. 2020	NCDB. 40-64 years old. 2011–2016	Breast, colon, non-small cell lung	848,329	Yes, 24% more Medicaid-insured and 55% fewer uninsured in Medicaid expansion states	Yes, 4.4% increase in early-stage diagnoses, 2.2% fewer late-stage diagnoses in expansion states. No time to treatment initiation difference between expansion and non-expansion states	Not studied.
43. Ajkay et al. 2018	Kentucky Cancer Registry. Women. 20-64 years old. 2011–2016.	Breast	1,315,965	Yes, 73% fewer uninsured, 54% more via Medicaid	Yes, earlier stage (up 3.4%; 2.2ppt), earlier treatment (5.1% sooner)	Not studied.
44. Cawley et al. 2018	BRFSS. Low-income childless adults. 19–64 years old. 2010–2016	Breast and cervical	80,200	Yes, 16.7% more insured	No screening change, but better access to care overall	Not studied.
45. Nikpay et al. 2018	BRFSS. All-Cancer survivors. 18–64 years old. 2011–2015	All Cancer	17,381	Yes, 52.6% fewer uninsured	Yes, care (9ppt) & meds (14ppt) both more affordable	Not studied.
46. Alharbi et al. 2019	MEPS. Women. Low-income. <65 years old. 2012–2016.	Breast and cervical	13,078	Yes, 100% more insured via Medicaid	No, mammograms at the same rate and Papanicolaou tests at a lower rate	Not studied.
47. Gan et al. 2019	Kentucky Cancer Registry and Kentucky Hospital Discharge Database. 20+ years old. 2011–2016	Colorectal	930,176	Yes, 230% increase in screened Medicaid insured	Yes, more diagnosed, earlier stage, better survival (Hazard Ratio = 0.73)	Yes, patients from Appalachian parts of Kentucky (rural) saw 199% increase in Medicaid and 77.7% decrease in uninsured. Early stage diagnosis increased 9.3% for Appalachians post-expansion
48. Hendryx et al. 2018	BRFSS. Low-income childless adults. 18–64 years old. 2012 vs. 2016.	Breast, cervical, and colorectal	56,959	Not studied.	Yes, greater screening rates: cervical (2ppt) and colorectal (3.2ppt) (Expansion vs. Non-expansion states)	Yes, helped reduced gap in screening between low and high income folks.
49. Zerhouni et al. 2019	BRFSS. White, Black, and Hispanic respondents with complete demographic answers. Age 50–64 years old. 2012–2016	Colorectal	341,350	Not studied.	No, 8% more likely to get colorectal cancer screening in expansion states than non-expansion states, but no increase after 2014 Medicaid expansion	No, no statistically significant changes in disparities after 2014 Medicaid expansion. Statistically significant changes in race (Whites relative to Blacks and Hispanics) and income disparity reduction only seen in states that expanded Medicaid prior to 2014.
Summary	17 from national/multi-state databases, 7 from national surveys, 2 from Kentucky databases	All Cancer (6), Breast (11), Gastrointestinal (11), Gynecologic (9), Lung (7), Squamous Cell Carcinoma (2), Urologic (6)	10,928,809	21 out of 21 articles	15 out of 21 articles	16 out of 17 articles

Abbreviations: ADVANCE (Accelerating Data Value Across a National Community Health Center Network), BRFSS (Behavioral Risk Factor Surveillance System), HCUP-SID (Healthcare Cost and Utilization Project - State Inpatient Databases), MEPS (Medical Expenditure Panel Survey), NAACR (North American Association of Cancer Registries), NCDB (National Cancer Database), SEER (Surveillance, Epidemiology, and End Results Program); ppt (Percentage Point); FPL (Federal Poverty Level).