Background: Lung cancer is the leading cause of cancer-related death in the US. Non-elderly, early stage (stage I&II) non-small cell lung cancer (NSCLC) patients have the most promising prognosis with appropriate treatments. Studies have shown uninsured and elderly patients on Medicaid being less likely to receive guideline-concordant therapy and thus with higher mortality. However, it remains unknown how insurance status influences cause-specific survival in non-elderly NSCLC patients, and whether disparity of care is improved in this cohort after ACA. Methods: Surveillance, Epidemiology, and End Results Program from 2007-2014 was used to identify NSCLC patients on stage I and II on diagnosis. Elderly patients ( > 65 years) were excluded. Demographic and lung cancer characteristics including age, gender, race, education, income, insurance status, tumor grade/stage and treatment were analyzed. Competing risk analysis was conducted using SAS9.4. Results: A total of 13,898 patients were included. After adjusting for socio-demographic factors, tumor grade and treatment, Medicaid and non-insured were associated with higher lung cancer mortality (HR: Medicaid 1.30 (1.17-1.44), non-insured 1.26 (1.05-1.50)). Patients with any Medicaid sustain the highest mortality for cardiovascular diseases(CVD) and non-cancer respiratory diseases(NCR) across different insurance status (CVD HR: Medicaid 2.17 (1.57-2.99), non-insured 1.37 (0.74-2.56); NCR HR: Medicaid 2.46 (1.76-3.43), non-insured 0.73 (0.30-1.81)). Diagnosis after ACA was associated with lower lung cancer specific mortality but not related to CVD or NCR mortality. No effect modification was found for diagnosis after ACA on any specific cause mortality. Conclusions: Despite ACA and Medicaid expansion in 2010, Medicaid and non-insured patients have higher cancer mortality compared with insured in early-stage NSCLC patients. Furthermore, non-elderly, early-stage NSCLC cancer survivors with Medicaid have remarkably higher CVD mortality compared to private insured survivors even without any insurance, which may reflect the disparity in health literacy, primary care, and cancer survivorship care access.