State Medicaid expansion status, insurance coverage and stage at diagnosis in head and neck cancer patients

Nosayaba Osazuwa-Peters, Justin M. Barnes, Uchechukwu Megwalu, Eric Adjei Boakye, Kenton J. Johnston, Matthew E. Gaubatz, Kimberly J. Johnson, Neelima Panth, Rosh K.V. Sethi, Mark A. Varvares

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Objectives: Only one in three head and neck cancer (HNC) patients present with early-stage disease. We aimed to quantify associations between state Medicaid expansions and changes in insurance coverage rates and stage at diagnosis of HNC. Methods: Using a quasi-experimental difference-in-differences (DID) approach and data from 26,330 cases included in the Surveillance, Epidemiology, and End Results program (2011–2015), we retrospectively examined changes in insurance coverage and stage at diagnosis of adult HNC in states that expanded Medicaid (EXP) versus those that did not (NEXP). Results: There was a significant increase in Medicaid coverage in EXP (+1.6 percentage point (PP) versus) vs. NEXP (-1.8 PP) states (3.36 PP, 95% CI = 1.32, 5.41; p = 0.001), and this increase was mostly among residents of low income and education counties. We also observed a reduction in uninsured rates among HNC patients in low income counties (−4.17 PP, 95% CI = −6.84, −1.51; p = 0.002). Overall, early stage diagnosis rates were 28.3% (EXP) vs. 26.7% (NEXP), with significant increases in early stage diagnosis post-Medicaid expansion among young adults, 18–34 years (17.2 PP, 95% CI – 1.34 to 33.1, p = 0.034), females (7.54 PP, 95% CI = 2.00 to 13.10, p = 0.008), unmarried patients (3.83 PP, 95% CI = 0.30–7.35, p = 0.033), and patients with lip cancer (13.5 PP, 95% CI = 2.67–24.3, p = 0.015). Conclusions: Medicaid expansion is associated with improved insurance coverage rates for HNC patients, particularly those with low income, and increases in early stage diagnoses for young adults and women.

Original languageEnglish
Article number104870
JournalOral Oncology
StatePublished - Nov 2020
Externally publishedYes


  • Access to care
  • Affordable Care Act (ACA)
  • Head and neck cancer (HNC)
  • Health disparities
  • Health insurance
  • Medicaid expansion
  • SEER
  • Stage at diagnosis


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