Abstract
The Affordable Care Act's (ACA’s) Medicaid expansion (ME) has improved cancer surgery access in urban states. However, its impact in the Midwest, home to a large rural population, remains under-studied. Pancreatic surgery requires access to high-volume hospitals (HVH), often found in urban areas. This study examined how ME affected rates of pancreatic surgery in the Midwest.
Data from State Inpatient Databases (2010-2022) of nine expansion or non/late-expansion Midwest states from Medicaid-eligible patients who underwent pancreatectomy for neoplasm were included. Interrupted time-series models were estimated for pancreatic surgery rates per 100,000 people across pre-expansion (2010-2013) and post-expansion (2014-2022), stratified by expansion status, and separately evaluated by payor, rurality, and HVH status (≥20 pancreatic cases/year).
A total of 10,168 pancreatectomies were identified, with 75% in expansion states, including 39% among rural patients and 79% performed at high volume hospitals. The ACA did not significantly increase pancreatic surgery rates (expansion states p= 0.325, non-expansion states p= 0.904). Among Medicaid beneficiaries, surgery rates showed a slight increase prior to ME in non-expansion states but not within other payer types. The growth in use of HVH preceded the ACA and continued with this trajectory after ME (expansion states p= 0.356, non-expansion states p= 0.413).
Medicaid beneficiaries in the Midwest did not experience increased rates of pancreatic surgery following ME suggesting insurance coverage alone is insufficient to increase receipt of surgical care. Future investigations should examine barriers beyond healthcare coverage that may limit rural patients’ ability to receive pancreatic surgery in the Midwest.
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