title: ACA-mandated elimination of cost sharing for preventive screening has had limited early impact.
abstract: OBJECTIVE
  The Affordable Care Act eliminated patient cost sharing for evidence-based preventive care, yet the impact of this policy on colonoscopy and mammography rates is unclear. We examined the elimination of cost sharing among small business beneficiaries of Humana, a large national insurer.
  
  
  METHODS
  This was a retrospective interrupted time series analysis of whether the change in cost-sharing policy was associated with a change in screening utilization, using grandfathered plans as a comparison group.
  
  
  METHODS
  We compared beneficiaries in small business nongrandfathered plans that were required to eliminate cost sharing (intervention) with those in grandfathered plans that did not have to change cost sharing (control). There were 63,246 men and women aged 50 to 64 years eligible for colorectal cancer screening, and 30,802 women aged 50 to 64 years eligible for breast cancer screening. The primary outcome variables were rates of colonoscopy and mammography per person-month, with secondary analysis of colonoscopy rates coded as preventive only.
  
  
  RESULTS
  There was no significant change in the level or slope of colonoscopy and mammography utilization for intervention plans relative to the control plans. There was also no significant relevant change among those colonoscopies coded as preventive.
  
  
  CONCLUSIONS
  The results suggest that the implementation of the policy is not having its intended effects, as cost sharing rates for colonoscopy and mammography did not change substantially, and utilization of colonoscopy and mammography changed little, following this new policy approach.
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, 1318 Blockley Hall, 423 Guardian Dr, Philadelphia, PA 19104. E-mail: shivan.mehta@uphs.upenn.edu.
authors.forename: Shivan J
authors.initials: SJ
authors.lastname: Mehta
authors.forename: Daniel
authors.initials: D
authors.lastname: Polsky
authors.forename: Jingsan
authors.initials: J
authors.lastname: Zhu
authors.forename: James D
authors.initials: JD
authors.lastname: Lewis
authors.forename: Jonathan T
authors.initials: JT
authors.lastname: Kolstad
authors.forename: George
authors.initials: G
authors.lastname: Loewenstein
authors.forename: Kevin G
authors.initials: KG
authors.lastname: Volpp
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis; D003113:Colonoscopy / Q000191:economics / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000175:diagnosis; D003669:Deductibles and Coinsurance / Q000191:economics / Q000331:legislation & jurisprudence*; D055088:Early Detection of Cancer / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D065186:Interrupted Time Series Analysis; D008297:Male; D008327:Mammography / Q000191:economics / Q000706:statistics & numerical data*; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act / Q000331:legislation & jurisprudence*; D012189:Retrospective Studies; D014481:United States