Mammograms Increased After ACA. Colonoscopies Did Not.

The Affordable Care Act's goal of boosting preventive cancer screenings did not succeed everywhere.

Out-of-pocket costs have historically been a big barrier to accessing recommended preventive cancer screenings. The ACA eliminated many of those out-of-pocket costs, but a new study shows mixed results.

The study, published early online in the journal CANCER, found that use of mammography, but not colonoscopy, increased after the ACA.

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Researchers at Ohio's University Hospitals Cleveland Medical Center and Case Comprehensive Cancer Center aimed to determine changes in the use of mammography and colonoscopy among fee-for-service Medicare beneficiaries before and after the ACA's implementation.

To do so, they examined Medicare claims data for two groups:

• Women who were 70 years old or older and had not undergone mammography in the previous 2 years.
   
• Men and women who were 70 years old or older, were at increased risk for colorectal cancer, and had not undergone colonoscopy in the past 5 years.

The team also identified which patients were screened in the two-year period prior to the ACA's implementation.

The researchers found that eliminating out-of-pocket costs helped some people, but not everyone.

After out-of-pocket costs for cancer screenings were eliminated, mammography usage increased among all economic subgroups, including the poorest people. On the other hand, preexisting disparities based on socioeconomic status in colonoscopy did not change.

Hidden Costs
Why the difference? Investigators suspect that it may be because out-of-pocket costs for the procedure itself aren't the only "costs" associated with colonoscopy. The procedure requires bowel preparation. And a subset of colonoscopies still requires out-of-pocket expenses.

Per CMS's rules on preventive screenings for colon cancer: "If a screening colonoscopy or screening flexible sigmoidoscopy results in the biopsy or removal of a lesion or growth during the same visit, the procedure is considered diagnostic and [the patient] may have to pay coinsurance and/or a copayment, but the Part B deductible doesn't apply."

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"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," lead author Gregory Cooper, MD, of University Hospitals Cleveland Medical Center and the Case Comprehensive Cancer Center, said in a statement.

"The findings have implications for other efforts to provide services to traditionally underserved patients, including the use of Medicaid expansion."

The research also shines additional light on how related expenses, such as transportation, living expenses, and lost wages, can affect whether a person has access to healthcare.

Other recent research from Massachusetts General Hospital and published in JAMA Internal Medicine shows that patients who got financial help with expenses than can affect their health also demonstrated modest but significant improvements in cardiovascular risk factors.