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Did Affordable Care Act Reduce Socioeconomic Disparities in Cancer Screening?

Investigators look at effect of eliminating out-of-pocket costs

Out-of-pocket expenditures are thought to be a significant barrier to receiving cancer preventive services, especially for individuals of lower socioeconomic status. A new study from the University Hospitals Cleveland Medical Center and the Case Comprehensive Cancer Center has looked at how the Patient Protection and Affordable Care Act (PPACA), which eliminated such out-of-pocket expenditures, affected the use of mammography and colonoscopy. Published online in Cancer, the study found that the use of mammography, but not colonoscopy, increased after the PPACA was passed.

To determine changes in the use of mammography and colonoscopy among fee-for-service Medicare beneficiaries before and after implementation of the PPACA, lead investigator Gregory Cooper, MD, and his colleagues examined Medicare claims data, identifying women 70 years of age and older without mammography during the previous two years and men and women in the same age group at increased risk for colorectal cancer without colonoscopy during the past five years. The team also identified patients who were screened in the two-year period before the PPACA’s implementation (2009 to 2010) and after its implementation (2011 to September 2012).

After out-of-pocket expenses for recommended cancer screening under the PPACA were eliminated, the uptake of mammography increased in all economic subgroups, including the poorest individuals. On the other hand, pre-existing disparities based on socioeconomic status in colonoscopy did not change. The investigators suspected that this might be due to other barriers related to colonoscopy, such as the need for bowel preparation or a loophole where a subset of colonoscopies still require out-of-pocket expenses.

“Although the future of the [PP]ACA is now questioned, the findings do support, at least for mammography, that elimination of financial barriers is associated with improvement in cancer screening,” Cooper said. “The findings have implications for other efforts to provide services to traditionally underserved patients, including the use of Medicaid expansion.”

At this point, it is not known which, if any, of the PPACA provisions will be continued under the new administration. Representative Tom Price, the nominee for head of the Department of Health and Human Services, had previously drafted a bill, the Empowering Patients First Act, that outlined proposed changes in health care; however, details of specific requirements for both private and government-funded insurance programs, including coverage for recommended preventive services, were not included in that plan.

Sources: Wiley; January 9, 2017; and Cancer; January 9, 2016.

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