Affordable Care Act Provision Lowered Out-of-Pocket Cost and Increased Colonoscopy Rates Among Men in Medicare

Published in: Health Affairs, v. 34, no. 12, Dec. 2015, p. 2069-2076

Posted on RAND.org on December 11, 2015

by Mary K. Hamman, Kandice A. Kapinos

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Research Questions

  1. Did the reduction in out-of-pocket expenses for colonoscopy screening resulting from the implementation of the Affordable Care Act change screening behavior in Medicare-aged seniors aged 66-75?
  2. Did economically vulnerable elderly populations benefit more than other groups?

BACKGROUND: Beginning January 1, 2011, section 4104 of the ACA made two important changes in cost sharing for colonoscopies. First, it waived deductibles for all colonoscopies, both screening and therapeutic. Second, it eliminated coinsurance for screening colonoscopies, but not for therapeutic ones. PURPOSE: To examine whether the reduction in expected out-of-pocket expenses for colonoscopy resulting from the implementation of section 4104 was associated with changes in screening behavior in the population ages 66-75. Methods: Using data from the Behavioral Risk Factor Surveillance System (BRFSS), we estimated changes in annual colonoscopy rates before and after January 2011 and within certain socioeconomic groups to determine whether the policy might have helped the economically vulnerable elderly more than other groups. RESULTS: For men, we found that the probability of having had a colonoscopy within the past year increased by 4.0 percentage points, or approximately 20 percent, after implementation of section 4104. However, our estimates suggested no significant change in screening rates for women. Estimates by household income group indicated that screening increased most among men with annual household incomes of $25,000-$34,999, but the evidence for higher screening rates among all lower-income men is inconsistent. Among women, our estimates indicated that screening did not increase significantly in any income group. CONCLUSIONS: Our research indicates that cost may be an important barrier to colorectal cancer screening, at least among men, and that making further policy changes to close remaining loopholes may improve screening rates.

Key Findings

  • There were significant increases in colonoscopy rates among men after implementation of the ACA provisions that reduced expected out-of-pocket expenses for colonoscopy.
  • Increases appear to be concentrated among men who stated that medical costs were a barrier to care, were less educated, and were in certain lower-income groups.
  • There was no significant evidence of improvement in colonoscopy rates among women.

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