Colorectal Cancer Screening in the Era of the Affordable Care Act

Background

The Affordable Care Act (ACA) eliminated cost-sharing for evidence-based preventive services in an effort to encourage use.

Objective

To evaluate use of colorectal cancer (CRC) screening in a national population-based sample before and after implementation of the ACA.

Design

Repeated cross-sectional analysis of the Medical Expenditure Panel Survey (MEPS) between 2009 and 2012 comparing CRC screening rates before and after implementation of the ACA.

Participants

Adults 50–64 with private health insurance and adults 65–75 with Medicare.

Main Measures

Self-reported receipt of screening colonoscopy, sigmoidoscopy, or fecal occult blood test (FOBT) within the past year among those eligible for screening.

Key Results

Our study included 8617 adults aged 50–64 and 3761 adults aged 65–75. MEPS response rates ranged from 58 to 63%. Among adults aged 50–64, 18.9–20.9% received a colonoscopy in the survey year, 0.59–2.1% received a sigmoidoscopy, and 7.9–10.4% received an FOBT. For adults aged 65–75, 23.6–27.7% received a colonoscopy, 1.3–3.2% a sigmoidoscopy, and 13.5–16.4% an FOBT. In adjusted analyses, among participants aged 50–64, there was no increase in yearly rates of colonoscopy (?0.28 percentage points, 95% CI ?2.3 to 1.7, p?=?0.78), sigmoidoscopy (?1.1%, 95% CI ?1.7 to ?0.46, p?=?<0.001), or FOBT (?1.6%, 95% CI ?3.2 to ?0.03, p?=?0.046) post-ACA. For those aged 65–75, rates of colonoscopy (+2.3%, 95% CI ?1.4 to 6.0, p?=?0.22), sigmoidoscopy (+0.34%, 95% CI 0.88 to 1.6, p?=?0.58) and FOBT (?0.65, 95% CI ?4.1 to 2.8, p?=?0.72) did not increase. Among those aged 65–75 with Medicare and no additional insurance, the use of colonoscopy rose by 12.0% (95% CI 3.3 to 20.8, p?=?0.007). Among participants with Medicare living in poverty, colonoscopy use also increased (+5.7%, 95% CI 0.18 to 11.3, p?=?0.043).

Conclusions

Eliminating cost-sharing for CRC screening has not resulted in changes in the use of CRC screening services for many Americans, although use may have increased in the post-ACA period among some Medicare beneficiaries.

Electronic supplementary material

The online version of this article (doi:10.1007/s11606-015-3504-2) contains supplementary material, which is available to authorized users.KEY WORDS: colorectal cancer, health care reform, health insurance, preventive care