OBJECTIVES: To determine whether the Affordable Care Act’s elimination of cost-sharing affected guideline-concordant use of cancer preventive screenings.

METHODS: Adults (≥21 years) from 2009 and 2011-14 Medical Expenditure Panel Survey (MEPS) were included. Participants in each year were divided into 3 groups: aged 21-64 years with any private insurance, aged ≥65 years with Medicare only and aged 21-64 years uninsured. Study sample for each type of screening was defined separately: women aged 21-65 years (cervical cancer [Pap test]), women aged ≥40 years (breast cancer [mammography]) and adults aged 50-75 years (colorectal cancer [CRC, screenings–blood stool test, sigmoidoscopy, or colonoscopy]). Receipt of screening consistent with recommended frequency was determined. Prevalence and prevalence ratios (PR[95% CI]) were multivariate-adjusted and weighted to be nationally representative. Stratified analyses by race/ethnicity (and by sex for CRC screening) were also conducted.

RESULTS: In 2014 (vs. 2009), privately insured women had 2% (0.98[0.97, 0.99]) and 4% (0.96[0.93, 0.99]) decline in receipt of Pap test and mammography. Privately insured Non-Hispanic (NH) White and Asian women had 2% (0.98[0.96, 1.00]) and 6% (0.94[0.88, 1.00]) reduction in receipt of Pap test in 2014 (vs. 2009), respectively (all p<0.10). Privately insured NH Asian women had 16% (0.84[0.74, 0.97]) reduction in receipt of mammography in 2014 (vs. 2009). In 2011 (vs. 2009), 9% (1.09[1.03, 1.16]) and 13% (1.13[1.02, 1.25]) increases in receipt of CRC screening were found among privately and Medicare-only insured men, respectively. Privately insured women had 7-6% rise in 2013-14 (vs. 2009) and Hispanic Medicare beneficiaries also had significant rise 2011-14 (vs. 2009), in receipt of CRC screening.

CONCLUSIONS: A stable-to-declining trend in guideline-recommended screening for cervical and breast cancers were observed in 2011-2014 compared to 2009. ACA’s elimination of cost-sharing appeared to have positively affected CRC screening of privately insured males, females and Medicare-only insured males and Hispanics.