Campus Connection

The Affordable Care Act has done nothing to decrease political rancor between the country’s two major political parties, but it has persuaded more men on Medicare to get colorectal screenings. In fact, colonoscopy rates among men ages 66-75 increased more than 20 percent after the Affordable Care Act reduced out-of-pocket costs for those on Medicare getting the cancer screening. Those were the findings of a nationwide study conducted by University of Wisconsin-La Crosse Assistant Professor of Economics Mary K. Hamman and RAND Corp. Economist Kandice Kapinos of Arlington, Virginia. Their findings were released in an article, “Affordable Care Act Provision Lowered Out-of-Pocket Cost and Increased Colonoscopy Rates Among Men in Medicare,” published in the December 2015 issue of Health Affairs. Colorectal cancer screening has an “A” rating from the U.S. Preventive Services Task Force because of its substantial health benefit — catching cancer early before healthcare costs begin to mount. But 40 percent of those who should receive the screenings don’t — in part because billing loopholes left Medicare beneficiaries with a lot uncertainty over how much a colonoscopy would cost. But the Affordable Care Act partially closed the colonoscopy loopholes and reduced out-of-pocket expenses for Medicare patients. The effect: annual screening rates among men rose by four percentage points. Although that may sound small, colonoscopies are only recommended every 10 years for average risk people. So a four percentage point increase in annual screening rates is a large change. The study found no significant increases among women. This is the third study Hamman has conducted that finds reducing out-of-pocket costs of screenings increases colonoscopy rates among men. “So while the results were not surprising, the fact the we find similar behavior after a different policy change makes us more confident in the conclusion that price does influence screening rates for men,” says Hamman. But for women, like their previous studies, she says there is no clear effect for screening rates. Hamman says their article points to remaining loopholes that lead Medicare beneficiaries to receive higher than expected bills after having colonoscopies. “We believe this paper plays an important role in the policy debate surrounding proposed legislation that would address these remaining loopholes,” she says. While colorectal cancer is the third leading cause of cancer death for men and women, there is a nearly 90 percent survival rate if it’s found early. Colonoscopies are expensive for Medicare and those being screened, says Hamman, but cancer has even higher medical costs, along with earlier mortality. Hamman says their findings could be key as talk continues about changes to the health care law. “We think this study may provide some early evidence on how the expansion in coverage for preventive care under the Affordable Care Act may lead to healthcare cost reductions and improvements in health,” she says. Hamman and her research colleagues plan more research into why the Affordable Care Act hasn’t increased screenings among women. “We are starting by examining behavior among married and cohabiting couples to see whether households may be prioritizing men's screenings before women's,” she says.