Health Insurance Coverage Mandates: Colorectal Cancer Screening in the Post-ACA Era.

Preston, Michael A; Ross, Levi; Chukmaitov, Askar; Smith, Sharla A; Odlum, Michelle L; Dahman, Bassam; Sheppard, Vanessa B

Building a culture of precision public health requires research that includes health delivery model with innovative systems, health policies, and programs that support this vision. Health insurance mandates are effective mechanisms that many state policymakers use to increase the utilization of preventive health services, such as colorectal cancer (CRC) screening. The current study estimated the effects of health insurance mandate variations on CRC screening post Affordable Care Act (ACA) era. The study analyzed secondary data from the Behavioral Risk Factor Surveillance System (BRFSS) and the National Cancer Institute State Cancer Legislative Database (SCLD) from 1997-2014. BRFSS data were merged with SCLD data by state ID. The target population was U.S. adults, age 50 to 74, who lived in states where health insurance was mandated or non-mandated before and after the implementation of ACA. Using a difference-in-differences (DD) approach with a time-series analysis, we evaluated the effects of health insurance mandates on CRC screening status based on U.S. Preventive Services Task Force guidelines. The adjusted average marginal effects from the DD model indicate that health insurance mandates increased the probability of up-to-date screenings vs. non-compliance by 2.8% points, suggesting that an estimated 2.37 million additional age-eligible persons would receive a screening with such health insurance mandates. Compliant participants' mean age was 65 years and 57% were women (n=32,569). Our findings are robust for various model specifications. Health insurance mandates that lower out-of-pocket expenses constitute an effective approach to increase CRC screenings for the population, as a whole.