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

Abstract

IntroductionThe 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.MethodsWe 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.ResultsApproximately 6.8 million low-income women would gain health insurance, potentially increasing the annual demand for 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.ConclusionImplementation 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.

Explaining variation across grantees in breast and cervical cancer screening proportions in the NBCCEDP

“…The Affordable Care Act is increasing access to insurance for millions of women, which provides coverage of breast and cervical cancer screening with no cost sharing. However, about half the states have not expanded Medicaid coverage under the law; therefore, a substantial number of low-income women will still likely be eligible for the screening services provided by the NBCCEDP [7]. In those states with Medicaid expansion, the NBCCEDP grantees will still provide screening services for those ineligible for insurance coverage and play an important role in referring low-income women for insurance coverage and in promoting and coordinating breast and cervical cancer screening and diagnostic services to ensure compliance with guideline recommendations.…”

Breast cancer screening of underserved women in the USA: results from the National Breast and Cervical Cancer Early Detection Program, 1998–2012

“…Previously, Levy et al [24] estimated that there will be 1.7 million low-income uninsured women aged 40–64 who remain eligible for the NBCCEDP in 2014 after implementation of the Affordable Care Act's major insurance expansion provisions. They conclude that the NBCCEDP “will still only be able to meet the needs of one-fifth to one-third of those eligible.” Levy et al assumed that coverage expansions under the Affordable Care Act would mirror the expansions that occurred in Massachusetts after it implemented its reform in 2006.…”

Opting Out of Cervical Cancer Screening

“…19,20 Primary care physicians will be ideally positioned to offer cervical cancer screening to women who have not had regular care. To maximize this opportunity, efforts to understand and address the barriers to cervical cancer screening in primary care settings may be needed.…”