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 “I think the prevention-related provisions of the Affordable Care
Act helped to detect cancer at earlier and more treatable stages and
eventually will save lives,” said senior author Nengliang “Aaron”
Yao, a health-policy professor at the University of Virginia School
of Medicine in Charlottesville.
Before the Affordable Care Act, often called Obamacare, took effect,
people ages 65 and older who were insured under Medicare had to pay
$275 for colonoscopies, the report in Health Affairs says.
The Affordable Care Act (ACA) directed that colonoscopies be offered
for free.
From 2011, when the law took effect, until 2013, an additional 8,400
seniors, or 8 percent more than before, were diagnosed with
early-stage colorectal cancer, researchers estimated.
“The study does a very nice job of showing that when you remove
financial barriers to healthcare, health improves,” said Dr. Cary
Gross, a professor at the Yale School of Medicine, in New Haven,
Connecticut who was not involved in the study. “When the Affordable
Care Act granted more generous coverage, we were more likely to
detect cancer at an earlier stage.”
“This shows that when it comes to creating a new healthcare plan,
the devil’s in the details, and policymakers need to look at things
like how will the proposed changes affect cancer screening,” Gross
said in a phone interview.
Colorectal cancer is the second leading cause of U.S. cancer-related
deaths, according to the U.S. Centers for Disease Control and
Prevention, or CDC. Nearly 52,000 Americans died from colorectal
cancer in 2013.
Though research shows that screening reduces the risk of dying from
colorectal cancer, only 25 percent of uninsured people and 60
percent of insured people had been screened as recommended, a 2015
CDC study showed.
Both Yao and Gross would like President Donald Trump and Republican
lawmakers, who have pledged to repeal the ACA, to consider the
ramifications of the new study before ruling on future healthcare
legislation.
“I’m very concerned that policymakers who are trying to save money
by not covering cancer-prevention services are being penny-wise and
pound-foolish,” Gross said. “They may save money today, but we will
be paying a lot more taking care of patients with metastatic cancer
down the road.”
“I’m worried on behalf of our patients and our communities that
these great strides we’ve made against cancer will evaporate if the
important provisions of the Affordable Care Act, which ensure that
patients can access cancer screening services without additional
costs, are taken away,” he said.
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In the new study, researchers examined data from 18 cancer
registries across the U.S. They found no change in the number of
Medicare early-stage cancer diagnoses for breast cancer between the
period before Obamacare, from 2008 until 2010, until the period
after, from 2011 until 2013.
Mammography to screen for breast cancer became free for Medicare
patients under the ACA, but before that, it cost just $9 – a
significantly smaller financial barrier than the $275 cost of a
colonoscopy, Yao said in a phone interview.
In addition, breast cancer screening had been marketed more
successfully than colorectal screening before the ACA was enacted,
he said.
Gross noted that colonoscopies can actually prevent cancer, because
doctors can remove polyps during the procedure, whereas mammograms
only allow doctors to see growths in the breast.
The U.S. Preventive Services Task Force found convincing evidence
that colorectal cancer screening substantially reduces deaths in
adults between 50 and 75 years old, it said last year. The task
force recommended screening with colonoscopy, stool analyses or
flexible sigmoidoscopy combined with a fecal-occult blood test.
The new study could not determine the impact of free colonoscopies
on metastatic colorectal cancer rates or mortality from colorectal
cancer. Gross urged follow-up studies examining those numbers after
they become available.
SOURCE: http://bit.ly/2jhSW2H Health Affairs, online January 9,
2017.
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