ACA Reduced Socioeconomic Barriers to Cancer Screening

After the Patient Protection and Affordable Care Act (ACA) eliminated out-of-pocket expenses for recommended cancer screenings, use of mammography increased across socioeconomic groups; use of colonoscopy, however, did not.

Researchers published their findings online today in the American Cancer Society’s journal Cancer.

“Although the future of the ACA is now questioned, the findings do support, at least for mammography, that elimination of financial barriers is associated with improvement in cancer screening,” said researcher Gregory Cooper, MD, of University Hospitals Cleveland Medical Center and the Case Comprehensive Cancer Center. “The findings have implications for other efforts to provide services to traditionally underserved patients, including the use of Medicaid expansion.”

Dr Cooper and colleagues gauged the effect of ACA on the use of mammography and colonoscopy specifically among fee-for-service Medicare beneficiaries. Researchers looked at Medicare claims data for women age 70 or older who had not used mammography for the previous 2 years as well as claims data for men and women age 70 or older who had not used colonoscopy in the previous 5 years despite increased risk for colorectal cancer. They identified which patients received the procedures in the 2-year period prior to ACA implementation (2009 to 2010) and after ACA implementation (2011 to September 2012).

Use of mammography increased among all socioeconomic groups—even the poorest—after ACA implementation, researchers found. Yet preexisting socioeconomic disparities in the use of colonoscopy did not change. 

Researchers suspect other barriers, including the need for bowel preparation or a loophole in which some colonoscopies still result in out-of-pocket expenses, may be affecting colonoscopy use.

“The findings support the removal of out-of-pocket expenditures as a barrier to the receipt of recommended preventive services but emphasize that for colonoscopy, other factors such as a fear of sedation, perceived discomfort, and a need for bowel preparation should be considered,” the researchers concluded. “We suggest that future studies examine the ACA’s impact in other populations, including newly insured individuals.” —Jolynn Tumolo