The Patient Protection and Affordable Care Act's (ACA) elimination of co-pays for screening mammography in 2010 has had a positive benefit for commercially insured women across a variety of racial and income groups, a study published online April 13 in the Journal of Women's Health has found.
The results suggest that racial disparities in screening mammography have narrowed, particularly among African American women, wrote a team led by Dr. Soudabeh Fazeli Dehkordy of the University of San Diego in California.
"Among our sample of employer-based insured women, we found an upward trend in the proportion of women with zero cost sharing for screening mammography both before and after 2010 among all races/ethnicities and income levels," the researchers wrote.
Screening mammography uptake varies by sociodemographic characteristics, insurance status, and race/ethnicity, and disparities in breast cancer screening persist among vulnerable populations, the authors noted. Mammography utilization rates tend to be higher among women with public insurance other than Medicare compared with those with private insurance or Medicare.
"One barrier to screening mammography utilization, which potentially contributes to these disparities, is the out-of-pocket costs for screening," the team wrote.
Before 2009, the U.S. Preventive Services Task Force (USPSTF) recommended screening mammography every one to two years for women 40 years and older. In November 2009, the task force changed its guideline to biennial screening for women ages 50 to 74.
In 2010, the ACA mandated elimination of co-pays for preventive services rated by the USPSTF as level A or B, including screening mammography. But the impact of these two factors among women of different races and income levels has been unclear, according to the researchers.
Dehkordy's group investigated disparities in screening mammography use before and after the ACA's elimination of co-pays, focusing specifically on women's race/ethnicity and income level.
The team used data from Optum Clinformatics Data Mart between the years 2004 and 2014, a dataset that included 1.7 million commercially insured women between the ages of 40 and 74.
When it came to co-pay elimination trends, the authors found an overall statistically significant (p < 0.001) upward trend in the proportion of women with zero co-pays over time across all races, ethnicities, and income levels. Trend levels demonstrated greater upward change between 2004 and 2010 before stabilizing between 2010 and 2011. The team did find, however, that screening utilization leveled or showed a significant decline (p < 0.001) after the 2009 USPSTF recommendation revision in all income and racial groups except for African American women; their screening rates continued to increase after 2009.
| Mammography co-pay and screening among women ages 40 to 74 by race/ethnicity and income, pre and post ACA | |||
| Measure | 2009 | 2010 | 2011 |
| Percent with zero cost share | |||
| Asian women | 90.4% | 92% | 97.2% |
| African American women | 92.9% | 95% | 98% |
| Hispanic women | 92.4% | 92.6% | 97.7% |
| Caucasian women | 92% | 93% | 96.7% |
| Screening utilization | |||
| Asian women | 40.5% | 39.2% | 38.8% |
| African American women | 38.5% | 38.3% | 38.6% |
| Hispanic women | 38% | 36.3% | 37.3% |
| Caucasian women | 43.9% | 42.7% | 42.3% |
More research is needed to determine why the USPSTF's 2009 screening mammography recommendation revision had a different impact on women of different races, Dehkordy's team noted. But the study shows progress.
"These findings suggest that the racial gap in screening mammography has closed and potentially reversed among African American women with employer-based health plans," the group concluded. "It is important to continue monitoring screening utilization as healthcare policies and guidelines change, as the changes may affect disparities in screening between different racial and income groups."
