The use of mammography, but not colonoscopy, increased after the Affordable Care Act (ACA). The ACA eliminated out-of-pocket expenditures for preventive services, which can make these services accessible for people of lower socioeconomic status.1

This study specifically examined whether the ACA affected the use of mammography and colonoscopy for preventive screening. Researchers assessed changes in the use of mammography and colonoscopy in fee-for-service Medicare beneficiaries before and after implementation of the ACA.

They examined data from women aged 70 years and at increased risk for colorectal cancer without having undergone a colonoscopy in the previous 5 years. Researchers also assessed data from patients who were screened in 2009 to 2010, just before implementation of the ACA, and again in 2011 to 2012, immediately following the ACA’s implementation.

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After implementation of the ACA, use of mammography increased in all economic subgroups, including among the poorest subgroups. In contrast, pre-existing differences based on socioeconomic status in colonoscopy use did not change. The researchers suggested that this could be due to other obstacles related to colonoscopy, such as the need for bowel preparation. Bowel preparation for colonoscopy remains an out-of-pocket expense.

“Although the future of the ACA is now questioned, the findings do support, at least for mammography, that elimination of financial barriers is associated with improvement in cancer screening,” said first author Gregory Cooper, MD, program director of gastroenterology, University Hospitals Cleveland Medical Center and the Case Comprehensive Cancer Center, Cleveland, Ohio.

“The removal of out-of-pocket expenditures may overcome a barrier to the receipt of recommended preventive services, but for colonoscopy, other procedural factors may remain as deterrents,” concluded the authors.


1. Cooper GS, Kou TD, Dor A, Koroukian SM, Schluchter MD. Cancer preventive services, socioeconomic status and the Affordable Care Act. Cancer. 2017 Jan 9. doi: 10.1002/cncr.30476. [Epub ahead of print]