Medicaid expansion improves survival and surgical access for pancreatic cancer patients.

• Residents in states with early, on-time, and late Medicaid expansion had 2-year mortality reductions (hazard ratios ranging from 0.91 to 0.94).
• There was a 19% increase in the odds of surgical resection with Medicaid expansion (odds ratio 1.19).

Outcomes improved primarily after three years post-expansion, highlighting the need for equitable access initiatives, especially for lower-income patients.

• Geographic disparities in survival decreased, but income-related disparities persisted.