{"doi":"10.1016/j.jamcollsurg.2020.11.010","title":"Association of Medicaid Expansion with Diagnosis and Management of Colon Cancer","abstract":"In March 2010, Medicaid expansion under the Affordable Care Act (ACA) was signed into law and has subsequently provided insurance to 10 million Americans living with incomes at or below 138% of the federal poverty threshold.Although initially intended to be nationally implemented, a Supreme Court ruling ultimately allowed individual states to decide whether to participate in Medicaid expansion.As of early November 2020, 38 states and the District of Columbia had affirmed their participation. 1 After expansion of Medicaid in these states, the literature has firmly established the law's positive effect on healthcare for low-income families, demonstrating increased use of primary care, preventative care, and prescription medications, as well as reduced all-cause mortality. 1In the surgical realm, and for surgical oncology in particular, Americans have benefitted from Medicaid expansion through increased screening, lower stage cancer at the time of diagnosis, and improved probability of optimal care for urgent and complex surgical diseases. [2][3][4] In \"The association of Medicaid expansion with the diagnosis and management of colon cancer,\" Hoehn and colleagues 5 present novel and compelling evidence regarding the association between Medicaid expansion and improved colon cancer care in the US.Using the National Cancer Database (NCDB) and a quasi-experimental difference-in-difference model, the authors sought to determine whether Medicaid expansion had an impact on colon cancer staging, treatment decisions, surgical outcomes, and treatment facility characteristics.The authors report that Medicaid expansion was associated with more stage I diagnoses, stage I to III patients treated within 30 days of diagnosis, and stage IV patients receiving palliative care.Furthermore, Medicaid expansion was associated with fewer urgent and more minimally invasive operations, as well as treatment at integrated network programs.The key remaining question is, however: do these positive effects translate into improved cancer outcomes?Hoehn and colleagues 5 report no difference in certain short-term surgical outcomessurgical margins status, length of stay, readmission, and mortality.The authors propose that colon cancer care has become increasingly standardized nationwide, and that patients with stage I-III colon cancer undergo essentially the same technical resection, regardless of institution.Therefore, earlier diagnoses may not affect these short-term outcomes, though","journal":"Journal of the American College of Surgeons","year":2021,"id":209692,"datarank":0.16479184330021646,"base_score":1.0986122886681096,"endowment":1.0986122886681096,"self_citation_contribution":0.16479184330021646,"citation_network_contribution":0.0,"self_endowment_contribution":0.16479184330021646,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":2,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9376,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":331391,"name":"Daniel E. Abbott","orcid":"0000-0002-5539-0734","position":1,"is_corresponding":false},{"id":797381,"name":"Thomas M. Diehl","orcid":"0000-0001-5397-4579","position":0,"is_corresponding":true}],"reference_count":12,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-18T23:52:05.171356Z","pmid":"33451446","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}