Expert Commentary

Early detection of some cancers increased under Obamacare

After the Affordable Care Act made some cancer screenings routine, doctors began finding colorectal cancers earlier, when they are easier to treat.


When cancer is caught early, it is easier and cheaper to treat. The Affordable Care Act (ACA), also known as Obamacare, sought to help Americans catch the disease early by requiring insurers to pay for some types of preventative care as well as an annual checkup.

Before the ACA was introduced in 2010, mammograms to detect breast cancer were common and affordable. By contrast, the screening procedure for cancers in the colon and rectum, a colonoscopy, was expensive. It is also intimidating: The test requires a patient flush his or her bowels beforehand by drinking a formidable laxative.

The ACA made both of these routine screenings free to senior citizens with Medicare. It also made annual checkups free for everyone with this or other kinds of insurance. Research has shown that patients who regularly see a doctor are more likely to discuss preventative care and more likely to undergo a colonoscopy.

A new paper finds a sharp increase in the number of early colorectal cancer diagnoses after these changes took effect, suggesting that the ACA helped many individuals detect and get treatment sooner.

An academic study worth reading: “Affordable Care Act Changes to Medicare Led to Increased Diagnoses of Early-Stage Colorectal Cancer Among Seniors,” in Health Affairs, 2017.

Study summary: Using population data from the National Cancer Institute covering about 25 percent of the American population, Brett Lissenden and Nengliang Yao, both of the University of Virginia, estimate the impact of ACA policy changes on screenings for these two types of treatable cancers. They look at first-time cancer diagnoses from the years 2008 to 2013, which cover a period before and immediately after the ACA began (in 2011) requiring that Medicare fully pay for the tests. Looking at different age groups, they produce a sample including 4,428 observations. One limitation to their research, they acknowledge, is that generational lifestyle trends change overtime; for example, Americans today smoke less than they did a few decades ago.

Key takeaways:

  • Starting in 2011, the authors found an 8 percent increase per year in the number of early-stage colorectal cancer diagnoses. Extrapolated across the country, they estimate the ACA led to approximately 8,400 additional early-stage colorectal cancer diagnoses among seniors between 2011 and 2013.
  • These diagnoses grew by 6.7 percent for Americans aged 65 to 75 and by 10.5 percent for those aged 76 and older.
  • The increase for women (12.8 percent) was higher than for men (3.8 percent).
  • The authors found no correlation between the ACA and detection of cancers in the breast, uterus or pulmonary system. They note that the ACA did not substantially lower the cost of screenings for these ailments (the costs were already much lower than the colonoscopy).

Helpful resources:

The National Cancer Institute has detailed information on many cancers, including colorectal and breast cancer.

The Centers for Disease Control and Prevention also publishes data and information on a variety of conditions and health-related research, as does the National Institutes of Health.

Other research:

We have covered research on a variety of ACA-related issues, including the relationship between family-planning access and long-term economic outcomes, how the ACA has affected out-of-pocket costs for various methods of birth control, state health-care exchanges and the GOP position on the law.

We also profiled a December 2016 paper in JAMA on healthcare spending in the U.S. over the decades.

A 2015 study published in JAMA found the ACA increased the number of early-stage cervical cancer diagnoses in women aged 21 to 25.

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