We will provide new evidence on the effects of two insurance-related public policies designed to increase colon cancer screenings (typically fecal occult blood tests, colonoscopies, and flexible sigmoidoscopies): first, state mandates that require health insurance policies to cover the screenings; and second, the federal Affordable Care Act's 2010 preventive services mandate that required the majority of health insurance plans to cover USPSTF-rated colon cancer screenings without cost-sharing. Prior work finds modest and/or inconsistent effects of state insurance mandates on utilization of cancer screenings but uses data that has some key limitations, including no information on the type of insurance. Prior work examining the ACA has also found no effects but did not account for the fact that the majority of states had already adopted a state mandate prior to the ACA. This project will use restricted data from the National Health Interview Survey from 2000-2013 to study the effects of colon cancer insurance mandates and the ACA preventive services provision using quasi-experimental methods and several previously unstudied moderators such as: firm size, family history of cancer, colon cancer risk factors, and socioeconomic status (which may be relevant for cost-sharing prohibitions).
Colon cancer is one of the leading causes of cancer deaths in the United States despite that there are well accepted screening methods for catching it early and thus dramatically increasing survival chances. Because colon cancer screenings can be expensive, increased insurance coverage and generosity for screenings has the potential to substantially increase utilization. Our results will be relevant for designing optimal interventions to increase screening rates for colon cancer to their recommended levels.
