By Wendy Biddle, J.D.
Although the number of individuals getting screened and treated through the programs has decreased, the decline is due to states’ expansion of Medicaid eligibility.
Approximately 265,000 women in the U.S. were diagnosed with breast or cervical cancer in 2017, according to the most recently available data from the CDC. Early screenings and detection for cancer can improve patient outcomes and ultimately save lives. Yet research has shown that low income, uninsured and underinsured people face challenges in accessing timely screenings and treatment for breast and cervical cancer. The CDC’s National Breast and Cervical Cancer Early Detection Program (the Early Detection Program) provides screenings for low income individuals without insurance coverage. However, the number of people screened under this program has declined significantly in recent years, according to a new GAO report. The GAO conducted this study to examine the states’ use of Medicaid under the Breast and Cervical Cancer Prevention and Treatment Act of 2000 as well as the implementation of the Early Detection Program (GAO Report, GAO 21-35, October 2020).
In 2011, over 550,000 people were screened through the Early Detection Program, but in 2018 only approximately 296,000 were screened, a 46 percent decline from 2011. The biggest decline came in 2014 and corresponded to when key provisions of the Affordable Care Act were implemented. Also, a large number of states expanded their Medicaid programs and subsidized health insurance through exchanges were also available. So although there was a large decline in the number of people screened by the CDC program, there also was a decline on the number of people eligible in the 2013-2014 timeframe. People were able to get coverage through Medicaid or other programs and that contributed to the decline in the programs’ screenings.
Screenings for breast and cervical cancer are important features for early detection and treatment and can also save lives, and that while the number of screenings conducted through the CDC's Early Detection Program has declined, patients might be receiving screenings outside of this program as a result of the Affordable Care Act. But advocates warn there is still a concern there could be a population of people who do not have access to screenings that are either under Medicaid or the Affordable Care Act, specifically those that are underinsured.
Additionally, the GAO reported that in 2019 approximately 43,500 people were enrolled in Medicaid under the Treatment Act to receive treatment for breast or cervical cancer. This number is 13.3 percent decrease from 2016, which had approximately 50,000 people enrolled under the Treatment Act. Again, Medicaid expansion to adults with incomes at or below 133 percent of the federal poverty level was a key contributor to the enrollment decreases. More people were eligible for Medicaid under the new guidelines who would have previously been enrolled under the Treatment Act. For those states that expanded Medicaid eligibility, enrollment via the Treatment Act decreased by roughly 25 percent from 2016 to 2019. In non-expansion states, enrollment via the Treatment Act increased by 1 percent.
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