Elimination of ACA cost sharing fueled growth in mammography utilization

Eliminating cost sharing for mammography under the Affordable Care Act (ACA) resulted in an uptick in utilization of preventative cancer screening services by women, according to The New England Journal of Medicine.

After the ACA implemented requirements for many insurers and Medicare to eliminate cost-sharing measures for U.S. Preventative Service Task Force-recommended services, screening mammography rates jumped 6 percent among women in those plans, according to the NEJM study published online Jan. 18.

To put these findings in perspective, researchers pointed to past studies that found copayments of as little as $20 were associated with decreased rates of breast-cancer screenings of 8 to 11 percent.

Researchers from the Brown University School of Public Health and the Providence Veterans Affairs Medical Center analyzed 15,085 women ages 65 to 74 enrolled in Medicare Advantage plans that eliminated cost-sharing compared to 52,035 women in 48 Medicare advantage plans that had maintained full coverage for screening before and after the ACA.

“The elimination of cost sharing for screening mammography in Medicare Advantage plans was associated with increased use of this service among older women for whom screening is recommended,” wrote corresponding author Amal N. Trivedi, MD, an associate professor at Brown University, and colleagues.

Education matters

Researchers found the ACA change in policy had little effect on women of “lower educational attainment.” These relatively stagnant numbers also apply to Hispanic women with less awareness of the ACA than the general population, according to the study.

Authors suggest policy change alone is not likely to increase screening rates in these demographics. More education coupled with policy change is needed.

“These findings, along with the results of our study, support the importance of outreach to Hispanic women and socioeconomically vulnerable populations about reductions in cost sharing for preventive care and other similar value-based changes in insurance policies,” Trivedi et al. wrote. “Otherwise, such strategies may paradoxically increase disparities if affluent and better-educated patients are more likely to understand and respond to them.”

Uncertainty about the ACA

Authors expressed a broader concern about the possible repeal of the ACA. Although Republicans seem to lack the needed support to make sweeping changes to the law, repealing pieces of the law could pose problems for women seeking preventative care.

“Our findings must be considered in the context of the potential repeal of the ACA. If the cost-sharing provisions of the ACA are rescinded, our results raise concern that fewer older women will receive recommended breast-cancer screening,” Trivedi et al. wrote.