Impact of The Affordable Care Act's Elimination of Cost-Sharing on the Guideline-Concordant Utilization of Cancer Preventive Screenings in the United States Using Medical Expenditure Panel Survey

Healthcare (Basel). 2019 Mar 1;7(1):36. doi: 10.3390/healthcare7010036.


Currently available evidence regarding the association of the Affordable Care Act's (ACA) elimination of cost-sharing and the utilization of cancer screenings is mixed. We determined whether the ACA's zero cost-sharing policy affected the guideline-concordant utilization of cancer screenings, comparing adults (≥21 years) from 2009 with 2011⁻2014 data from the Medical Expenditure Panel Survey. Study participants were categorized as: 21⁻64 years with any private insurance, ≥65 years with Medicare only, and 21⁻64 years uninsured, with a separate sample for each type of screening test. Adjusted weighted prevalence and prevalence ratios (PR (95%CI)) were estimated. In 2014 (vs. 2009), privately-insured women reported 2% (0.98 (0.97⁻0.99)) and 4% (0.96 (0.93⁻0.99)) reduction in use of Pap tests and mammography, respectively. Privately-insured non-Hispanic Asian women had 16% (0.84 (0.74⁻0.97)) reduction in mammography in 2014 (vs. 2009). In 2011 (vs. 2009), privately-insured and Medicare-only men reported 9% (1.09 (1.03⁻1.16)) and 13% (1.13 (1.02⁻1.25)) increases in colorectal cancer (CRC) screenings, respectively. Privately-insured women reported a 6⁻7% rise in 2013⁻2014 (vs. 2009), and Hispanic Medicare beneficiaries also reported 40⁻44%, a significant rise in 2011⁻2014 (vs. 2009), in the utilization of CRC screenings. While the guideline-concordant utilization of Pap tests and mammography declined in the post-ACA period, the elimination of cost-sharing appeared to have positively affected CRC screenings of privately-insured males, females, and Hispanic Medicare-only beneficiaries. Greater awareness about the zero cost-sharing policy may help in increasing the uptake of cancer screenings.

Keywords: FOBT; Pap test; affordable care act; cancer screening; colonoscopy; colorectal cancer screening; cost-sharing; mammography; out-of-pocket payment; racial disparity.