Medicaid Expansion Leads to Long-Term Survival Trends in Breast Cancer

For Oluwasegun Akinyemi, MD, PhD, the journey toward researching US health policy began thousands of miles away. As an obstetrician and gynecologist in Nigeria, Akinyemi witnessed a recurring, heartbreaking pattern: women presenting with advanced-stage diseases when clinical intervention could offer little hope. This experience fueled a career transition from the bedside to the legislative data sheet.

"I started asking myself, 'How can I do more than just sitting down and attending to waiting for these women to come at an advanced stage of disease where I cannot do so much?'" Akinyemi explained. "I started learning about policy—that really, when you are involved with policy, policy can actually have a bigger impact on population health than when you are just sitting down and seeing patients."

Now a senior research fellow at the Howard University College of Medicine, Akinyemi recently published a study in JAMA Network Open investigating the association between Medicaid expansion and survival rates among women with breast cancer, specifically focusing on triple-negative breast cancer (TNBC).¹ In an interview regarding his findings, Akinyemi detailed how Medicaid expansion is more than a political talking point; it is a clinical lifesaver.

Moving Beyond Eligibility to Survival

While much of the existing literature on the Patient Protection and Affordable Care Act (ACA) focuses on insurance rates, Akinyemi wanted to look deeper into the actual outcomes of that coverage.

"Most studies focus on the benefit of Medicaid expansion,² increasing Medicaid eligibility, causing more individuals to have more insurance," he noted. "For me, I was interested in seeing how the improvement—increase in Medicaid beneficiaries, the reduction in uninsured rate—how that actually moves into improvement in survival, which was the most important thing."

Akinyemi’s research sought to determine if the survival benefits noted in earlier, short-term studies were durable.

"I wanted to look at it for a long period of time, to see whether the benefit, if there is any benefit, is sustained over time," he said. The results were definitive: "We found that it’s beneficial, it translates into improvement in survival, and that benefit is sustained over time. That’s the long and short of it."

Surprising Racial Disparities and the Blunting Effect

One of the most striking aspects of the study was how the benefits of expansion were distributed across different racial and ethnic groups. While the general public perception might suggest that Medicaid expansion primarily aids minority groups, Akinyemi found that the positive impact was universal.

"Virtually all races and ethnicities—everybody—benefit from Medicaid expansion," he said. "In this study, we found out that Whites, Blacks, and Hispanics actually benefited."

However, the degree of benefit varied in ways that surprised the research team. Hispanic women, who previously had the highest uninsured rates, saw the most significant gains. In contrast, the impact on non-Hispanic Black women was more muted than expected.

"We found out that Blacks moderately benefited from this," Akinyemi explained. Discussion with colleagues at Howard University highlighted a geographic explanation: "A lot of these women, Black women, live in nonexpansion states… That partly might have been what is responsible for the kind of blunting of the impact of that policy."

A Call to Policy Makers

For Akinyemi, the data sends a clear message to the medical community and the government. He emphasized that Medicaid expansion is "not just something to just politicize." Instead, he views it as a fundamental tool for reducing mortality across all demographics, regardless of income level or disease stage.

"To providers, the government, and policymakers…this is actually serious. This is not a joke. This is huge," Akinyemi said. "This policy is associated with significant reduction in mortality... and this is sustained over time."

Looking forward, Akinyemi is interested in the specific mechanisms—the "pathways"—that lead to these outcomes. He noted that even patients diagnosed with late-stage disease showed better outcomes in expansion states.

"Could it be because of early presentation, maybe access to better treatment?" he asked. He pointed to the utilization of advanced therapies, such as immunotherapy, as a potential factor.

As debates regarding the future of the ACA continue, Akinyemi hopes his research serves as a permanent record of the policy's efficacy.

"The direction the country is moving is moving in the direction of literally shutting down this program," he warned. "In 5 or 10 years' time, we have these kinds of studies that will be a reference point to us... so that if there’s anything, we can have this as evidence to revert back to these kinds of policies. It’s very important that everybody should have access to insurance."

REFERENCES

1. Akinyemi O, Oyebanji O, Fasokun M, et al. Medicaid expansion and overall mortality among women with breast cancer. JAMA Netw Open. 2026 Jan 2;9(1):e2554512. doi: 10.1001/jamanetworkopen.2025.54512. PMID: 41591779; PMCID: PMC12848628.

2. Buchmueller TC, Cliff BQ, Levy H. The benefits of Medicaid expansion. JAMA Health Forum. 2020 Jul 1;1(7):e200879. doi: 10.1001/jamahealthforum.2020.0879. PMID: 36218692.