A significant barrier to receiving cancer preventive services seems to be the out-of-pocket expenditures. This is especially true for individuals of lower socioeconomic status. The Affordable Care Act (ACA) has been reviewed in a new study as to how the act of eliminating such out-of-pocket expenditures has affected the use of mammography and colonoscopy. Cancer published a peer-reviewed journal of the American Cancer Society study that found use of mammography, but not colonoscopy, increased after the ACA.
Gregory Cooper, MD, of University Hospitals Cleveland Medical Center and the Case Comprehensive Cancer Center, and his colleagues examined Medicare claims data, to determine changes in the use of mammography and colonoscopy among fee-for-service Medicare beneficiaries before and after the ACA’s implementation. They identified women > 70 years old without mammography in the previous two years and men and women > 70 years old at increased risk for colorectal cancer without colonoscopy in the past five years. Patients that were screened in the two-year period prior to the ACA’s implementation and after its implementation were also identified.
The elimination of out-of-pocket expenses for recommended cancer screening under the ACA uptake of mammography increased in all economic subgroups, and this included the poorest individuals. Preexisting disparities based on socioeconomic status in colonoscopy did not change. It is suspected by the investigators that this may 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 an out-of-pocket expense.
The future of the ACA is now being questioned and the findings do support, at least for mammography, the elimination of financial barriers associated with improvement in cancer screening. Dr. Cooper was quoted as saying “The findings have implications for other efforts to provide services to traditionally underserved patients including the use of Medicaid expansion.”
As of now it is not known when, if any, of the ACA provisions will be continued under the new administration. A bill was previously drafted by Representative Tom Price, the nominee for Head of the Department of Health and Human Services (Empowering Patients First Act) that outlines proposed changes in health care. Details of specific requirements for both private and government funded insurance programs are not given, including coverage for recommended preventive services.
In order to honor an individual’s healthcare choice, the ACA should include coverage of non traditional care such as alternative treatment.
Dr Fredda Branyon