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 Researchers also found that when the law - often referred to as
Obamacare - went into effect, differences in screening rates between
wealthy, well-educated older women and their less well-off peers
became narrower.
"If you remove financial barriers, it will increase the uptake of at
least certain services and narrow the gap," said lead author Dr.
Gregory Cooper, of University Hospitals Cleveland Medical Center and
the Case Comprehensive Cancer Center in Ohio.
Cooper and his colleagues write in the journal Cancer that a major
goal of the 2010 law was to eliminate out-of-pocket costs for
certain preventive healthcare services, including screenings for
breast and colon cancers.
It was hoped, the researchers write, that the change would allow
more people with limited financial resources to be screened,
narrowing the cancer disparities that exist among women with
different social and economic statuses.
The researchers analyzed data collected between 2009 and 2012 from a
sample of people on Medicare, the government-run health insurance
program for the elderly and disabled, to see if eliminating out of
pocket costs had closed the gap between rich and poor and led to
more mammograms and colonoscopies. Study subjects were at least 70
years old.
Prior to the ACA's implementation in 2011, people on Medicare paid
20 percent of the cost for mammograms and 25 percent of the cost for
colonoscopies, according to the authors of the study.
After the law made the services available at no expense to the
patient, mammogram rates appeared to increase among women of all
income and education levels.
The breast cancer screening gap between wealthy and poor Medicare
recipients did narrow, the researchers found. Before passage of the
ACA, the poorest women were 13 percent less likely to get screening
mammograms than the richest women. After the law took effect, poor
women were only 6 percent less likely to be screened than their
wealthier peers.
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Similar narrowing was seen in the gap between highly educated and
less well-educated women.
The same was not true for colonoscopies.
Colonoscopies are more complicated than mammograms, however. They
require more effort from patients, who need to prep themselves
before the procedure, and patients may require sedation.
"For things that are more involved, cost may be only one step that
needs to be addressed," Cooper said.
Also, he noted, colonoscopies may still result in costs to patients
if doctors remove polyps during the procedure, because the procedure
would then be classified as "diagnostic" instead of "preventative."
It's unclear how the what will happen to these trends if Congress
repeals the ACA, Cooper said.
"I’m hoping that they will keep some preventive service no matter
what they end up doing," he said.
SOURCE: http://bit.ly/2jmu4nv Cancer, online January 9, 2017.
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