Affordable Care Act is boosting prevention, but more work is needed
CLAYTON BOLDT, PH.D.
The Affordable Care Act (ACA) was signed into law in 2010 to improve access to affordable health coverage for Americans, and a major focus of these efforts is ensuring preventive care for a number of diseases.
Up to half of all cancer deaths may be prevented through healthy lifestyle choices and appropriate screenings. Therefore, improving access to preventive care through the ACA has the potential for significant reductions in cancer incidence and mortality.
The most profound impact, according to Hawk, comes from making prevention and screening services a national priority.
“The ACA established the U.S. Preventive Services Task Force (USPSTF) as our nation’s authority to determine if sufficient evidence exists to recommend a prevention or screening service. That was a major change because previously no such body had been similarly empowered,” says Hawk.
“Most importantly, the legislation helped to prioritize prevention and screening culturally, placing it on par with treatment for the first time, by requiring payers to reimburse for evidence-based screening and preventive services for covered individuals.”
These clinical preventive services include screening for breast, cervical, colorectal and lung cancers, as well as behavioral counseling for skin cancer prevention. Additional services consist of annual wellness exams, tobacco and alcohol cessation services, immunizations, and management of chronic conditions such as obesity, all of which may help prevent cancers.
Based upon USPSTF recommendations, these services are now available to individuals with private insurance or Medicare with no cost-sharing such as copays or deductibles. According to the Department of Health and Human Services (DHHS), an estimated 137.7 million Americans had cost-share-free coverage for preventive services in 2015.
The power of communities and employers
When looking beyond individuals, the ACA has also helped to bolster the role of businesses and community organizations in promoting healthy lifestyles and cancer prevention. Employers are encouraged to improve employee health through various government assistance programs and initiatives as well as requirements for employee health.
The ACA has strengthened the vital role of communities in promoting prevention through state and community grant incentives designed to improve health care access, reduce disparities and increase adoption of healthy behaviors.
At the national level, numerous groups have come together under the ACA to coordinate strategy and financial support, direct focus for prevention research, and implement needed infrastructure.
Big investments paying off
These activities come with large investments, including up to $15 billion authorized for the Prevention and Public Health Fund between 2010 and 2020. Previously, only 3% of all health care spending focused on prevention, despite preventable conditions being responsible for 75% of costs.
This government support of cancer prevention has come with measurable gains. For example, an estimated 1.1 million additional women between the ages of 19 and 25 initiated the vaccine series for the human papillomavirus (HPV), and more than 850,000 additional young women completed the series.
Colorectal cancer screening rates have improved overall, particularly for men with lower education levels and those reporting cost as a barrier to screening. However, rates remain below 60%, far short of the target of 70.5% set by the DHSS Healthy People 2020 goals.
The Center for Disease Control and Prevention’s ‘Tips from a Former Smoker’ Campaign, supported by the Prevention and Public Health Fund, resulted in a 17% increase in those attempting to quit tobacco, and a 28% increase in those with intentions to quit in 2014.
A long way to go
Hawk is pleased with the results seen from the ACA so far, but feels there is still a need to do much better.
“To improve in the future, all Americans should have access to preventive services along with the requisite navigation to downstream diagnostics and treatments,” says Hawk. “Americans dying from preventable cancers such as HPV-related, hepatitis B/C-related or colorectal cancers should be extremely rare. Unfortunately, they are not at the moment.”
Hawk hopes that the experience gained can be used to eliminate preventable cancers worldwide.
“Once we’ve demonstrated the success of such efforts in our own country, we should be agents of change for effective dissemination beyond our borders.”