Cervical and colorectal cancer screening prevalence before and after Affordable Care Act Medicaid expansion

Abstract

Community health centers (CHCs), which serve socioeconomically disadvantaged patients, experienced an increase in insured visits after the 2014 Affordable Care Act (ACA) coverage options began. Yet, little is known about how cancer screening rates changed post-ACA. Therefore, this study assessed changes in the prevalence of cervical and colorectal cancer screening from pre- to post-ACA in expansion and non-expansion states among patients seen in CHCs. Electronic health record data on 624,601 non-pregnant patients aged 21–64 eligible for cervical or colorectal cancer screening between 1/1/2012 and 12/31/2015 from 203 CHCs were analyzed. We assessed changes in prevalence and screening likelihood among patients, by insurance type and race/ethnicity and compared Medicaid expansion and non-expansion states using difference-in-difference methodology. Female patients had 19% increased odds of receiving cervical cancer screening post-relative to pre-ACA in expansion states [adjusted odds ratio (aOR) = 1.19, 95% confidence interval (CI) = 1.09–1.31] and 23% increased odds in non-expansion states (aOR = 1.23, 95% CI = 1.05–1.46): the greatest increase was among uninsured patients in expansion states (aOR = 1.36, 95% CI = 1.16–1.59) and privately-insured patients in non-expansion states (aOR = 1.43, 95% CI = 1.11–1.84). Colorectal cancer screening prevalence increased from 11% to 18% pre- to post-ACA in expansion states and from 13% to 21% in non-expansion states. For most outcomes, the observed changes were not significantly different between expansion and non-expansion states. Despite increased prevalences of cervical and colorectal cancer screening in both expansion and non-expansion states across all race/ethnicity groups, rates remained suboptimal for this population of socioeconomically disadvantaged patients.

Impacts of the Affordable Care Act on Receipt of Women's Preventive Services in Community Health Centers in Medicaid Expansion and Nonexpansion States

“…(Blood pressure screening did not increase after ACA implementation among Medicaid nonexpansion states but was already very high before the ACA and remained high in both expansion and nonexpansion groups.) These findings are consistent with previous literature that suggests other preventive services like mammography and colorectal cancer screening increased overall after the implementation of the ACA (Alharbi et al, 2019;Huguet et al, 2019;Sun et al, 2018). Gains in preventive service delivery have previously been attributed to broad insurance expansion (both public and private) (Huguet et al, 2017), development of Accountable Care Organizations with incentivized focus on quality metrics (although the proliferation of Accountable Care Organizations was underway before Medicaid expansion in 2014) (Meyer et al, 2017), and additional resources for safety net health centers through federal grants and increased health insurance revenue (Han et al, 2017;Huguet et al, 2019).…”

“…Overall, receipt of preventive services among female CHC patients remained low despite broad improvements that were observed after implementation of the ACA and were present among both Medicaid expansion and nonexpansion states. Still, with the exception of the rate of flu vaccination in nonexpansion states (see the Limitations section), the observed prevalence of receipt of individual preventive services was roughly similar to other studies measuring preventive care in this population (Cowburn et al, 2013;Huguet et al, 2019;Walker et al, 2018), although they lag far behind aspirational metrics such as Healthy People 2020 (Office of Disease Prevention and Health Promotion, 2014). Reasons for a lack of consistent differences in pre-/post-ACA implementation delivery of services between Medicaid expansion and nonexpansion states are likely multifactorial and require further exploration in additional states and with additional types of services.…”

“…Since the implementation of the ACA, early studies suggest an increase in receipt of preventive services and other recommended health care (Huguet et al, 2018;Sabik & Adunlin, 2017;Sun, Cole, Lipsitz, & Trinh, 2018). A few studies compare these trends in Medicaid expansion states to those in nonexpansion states and find few differences in receipt of care (Alharbi, Khan, Horner, Brandt, & Chapman, 2019;Huguet et al, 2019). However, less is known about how ACA implementation has impacted women's preventive care, and one study showed young women had limited understanding of these new benefits, particularly if they had less education, had lower income, and were uninsured (Hall, Fendrick, Zochowski, & Dalton, 2014).…”

Examination of the Association Between Access to Care and Lung Cancer Screening Among High-Risk Smokers

“…Medicaid expansion has improved access to care among low-income individuals (49,50). More specifically, studies have found Medicaid expansion was associated with increased cancer screenings among low-income adults (51)(52)(53)(54). Illinois is one of the states with early implementation of Medicaid expansion (55).…”

Improving Multi-Tumor Biomarker Health Check-Up Tests with Machine Learning Algorithms

“…Furthermore, these tools usually detect only one cancer type, meaning that individuals may need to visit multiple medical services to receive different screening tests. These disadvantages lead to low compliance with cancer screening by these tools [ 8 ].…”