Health Care Reform and Women's Insurance Coverage for Breast and Cervical Cancer Screening

Alice R. Levy, PhD, MPP; Brian K. Bruen, MS; Leighton Ku, PhD, MPH

Disclosures

Prev Chronic Dis. 2012;9 

In This Article

Abstract and Introduction

Abstract

The Patient Protection and Affordable Care Act of 2010 (ACA) will increase insurance coverage for US citizens and for breast and cervical cancer screening through insurance expansions and regulatory changes. The primary objective of this study was to estimate the number of low-income women who would gain health insurance after implementation of the ACA and thus be able to obtain cancer screening. A secondary objective was to estimate the size and characteristics of the uninsured low-income population and the number of women who would still need National Breast and Cervical Cancer Early Detection Program (NBCCEDP) services.
Methods We used the nationally representative 2009 American Community Survey to estimate the determinants of insurance status for women in Massachusetts, assuming full implementation of the ACA. We extrapolated findings to simulate the effects of the ACA on each state. We used individual-level predicted probabilities of being uninsured to generate estimates of the number of women who would gain health insurance after implementation of the ACA and to predict demand for NBCCEDP services.
Results Approximately 6.8 million low-income women would gain health insurance, potentially increasing the annual demand for NBCCEDP cancer screenings initially by about 500,000 mammograms and 1.3 million Papanicolaou tests. Despite a 60% decrease in the number of low-income uninsured women, the NBCCEDP would still serve fewer than one-third of the estimated number of women eligible for services. The NBCCEDP-eligible population would comprise a larger number of women with language and literacy-related barriers to care.
Conclusion Implementation of the ACA would increase insurance coverage and access to cancer screening for millions of women, but the NBCCEDP will remain essential for the millions who will remain uninsured.

Introduction

The percentage of American women who receive mammograms has remained steady during the past decade, whereas the percentage who receive Papanicolaou (Pap) tests has declined slightly.[1] Screening and earlier treatment of breast and cervical cancer can reduce death rates,[2,3] but being uninsured reduces the likelihood of screening by about half.[1,4–8] A randomized experiment in Oregon demonstrated that an increase in Medicaid coverage increased the percentage of low-income women who received mammograms in the previous 12 months from 30% to 49% and increased the percentage who received Pap tests in the previous year from 41% to 58%.[9,10]

In 2014, the Patient Protection and Affordable Care Act of 2010 (ACA) will expand coverage for cancer screening by reducing the number of uninsured people and by requiring private insurance and Medicare to cover breast and cervical cancer screening without cost-sharing. These insurance expansions may increase the number of women who are screened. The National Breast and Cervical Cancer Early Detection Program (NBCCEDP), which provides breast and cervical cancer screening to low-income uninsured and underinsured women, is expected to continue to be needed by millions of women who will remain uninsured. The NBCCEDP contributes to reduced breast cancer death rates,[11] reduces time from cancer diagnosis to Medicaid enrollment, expands women's treatment options,[12] and changes the timing of diagnosis and treatment of cervical cancer.[13,14] The primary objective of this study was to estimate the number of low-income women who would gain health insurance and thus obtain cancer screening after implementation of the ACA. A secondary objective was to estimate the size and characteristics of the population who would still need NBCCEDP services.

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