One of the great benefits of the Affordable Care Act is that it eliminated out-of-pocket costs for screening procedures like mammograms and colonoscopies for many Americans. It also let health care researchers test a theory on why people get ― or don’t get ― such screenings.
“We know that as a whole, if you’re less affluent, you’re less likely to get most preventive care,” said Dr. Gregory Cooper, the gastroenterology program director at University Hospitals’ Cleveland Medical Center.
You’d think that one reason for this gap in preventive care is how much patients have to pay for the procedures themselves. But according to the authors of a new study, led by Cooper, there has been “little empirical evidence to support this contention.”
Their study, published in the journal Cancer in January, looked at how the ACA affected mammography and colonoscopy rates among Medicare beneficiaries. They found that mammography rates improved after the law went into effect, although colonoscopy rates didn’t.
Older women had more mammograms after Obamacare.
The study analyzed Medicare claims from patients who were 70 or older. The researchers compared claims from 2009 and 2010, before the ACA was implemented, with claims from 2011 and 2012, once the procedures were covered.
None of the female patients in each study period had had a mammogram in the two years prior. All the male and female patients were at increased risk for colorectal cancer, and none of them had had a colonoscopy in the prior five years.
Among women due for a mammogram, the screening rate increased from 5 percent to 7 percent per month.
In addition, Cooper said, “The gap actually narrowed. [The rates] went up in all groups. The differences between the wealthiest and the poorest narrowed after the ACA.”
The results were less encouraging for colonoscopy rates, which remained flat, at about 4 percent per month.
The researchers suggested one possible explanation: Unlike mammograms, colonoscopies require bowel prep and sedation, which could deter patients from getting the procedure.
ACA repeal could mean fewer get screened for cancer.
Chronic diseases ― including breast and colon cancer ― account for 7 out of 10 deaths in the United States and 75 percent of the country’s heath spending, according to the Centers for Disease Control and Prevention.
Yet many Americans skip preventive services that could catch such diseases early. In 2013, 1 in 5 women reported not being up-to-date with cervical cancer screenings, 1 in 4 women weren’t up-to-date with breast cancer screenings, and 2 in 5 adults weren’t up-to-date with colorectal cancer screenings, the CDC says.
So a health benefit that encourages more people to get screened seems valuable. But with President-elect Donald Trump and congressional Republicans vowing to repeal the ACA and replace it at lower cost, researchers and doctors worry that free preventive services might be on the chopping block.
“I don’t know what’s going to get salvaged,” Cooper said. “I haven’t heard anything about preventive care.”
One possibility is that patients may be required to share some of the costs for preventive services such as mammograms.
“That’s a disincentive,” Cooper warned.