Screening Test Use Up After ACA

There was an uptick in preventive screening after enactment of the Affordable Care Act (ACA), yet cancer-screening rates in the United States remain below Healthy People 2020 goals. More people received screenings to prevent cancer and heart disease in 2015 than in 2012, according to a March 2017 data brief from the National Center for Health Statistics (NCHS), although the growth in screening was not consistent.

The ACA was intended to improve access to health care through both greater numbers of insured and coverage of “essential health benefits” (certain clinical preventive services) without copayments.

Two studies led by researchers at the U.S. Centers for Disease Control and Prevention (CDC) used the 2015 National Health Interview Survey to assess utilization of screening services in a nationally representative adult civilian population. Actual screening rates were compared to the estimated number who should be screened based upon recommendations from the U.S. Preventive Services Task Force or national targets from Healthy People 2020.

• Colonoscopy: In 2015, just under two-thirds of insured adults aged 50 to 75 years were screened for colorectal cancer within the recommended intervals. This is up substantially from the colonoscopy rate of 49.1 percent the CDC reported in 2010.

  In the second study, published March 3 in Morbidity and Mortality Weekly Report (MMWR), the authors note the rate of colorectal cancer screening of 62.4 percent in 2015 is below the Healthy People 2020 target of 70.5 percent. Despite progress in increasing screening in many groups, low screening use was reported by persons without a usual source of health care (26.3 percent) and the uninsured (25.1 percent).

• Pap Testing: In 2015, more than 8 out of 10 insured women aged 21 to 65 years were screened for cervical cancer (83 percent) in accordance with recommendations. Cervical cancer screening test use was lowest (63.8 percent) among uninsured women.

  The screening rate for cervical cancer actually decreased slightly between 2000 and 2015 and remains below the target of 93.0 percent by 2020. However, the MMWR authors note that cervical cancer screening recommendations changed in 2012. The new extended screening intervals may have contributed to the slight decline in cervical cancer screening.

• Glucose Testing: In 2015, roughly two out of three overweight and obese insured adults aged 40 to 70 years had a fasting blood test for high blood sugar or diabetes in the past 12 months.

“The Affordable Care Act has helped to reduce such barriers by expanding insurance coverage and eliminating cost sharing, in most insurance plans, for preventive services,” write the MMWR authors, led by Arica White, Ph.D., from the CDC’s Division of Cancer Prevention and Control. “Persons without a usual source of health care and the uninsured had the lowest test use, with the overwhelming majority of the uninsured not up to date with breast and colorectal cancer screening.”