Close the gap

Ensure coverage, limit health costs

The medical journal Health Affairs recently published a study, “The Effect of the Affordable Care Act On Cancer Detection Among The Near-Elderly.” It cost me $21 for access to it for 24 hours, so pay attention, and I’ll save you $21.

First, some background. In 2013, before the Affordable Care Act (ACA) kicked in, 16.7% of Americans from age 0-64 were uninsured. By 2018, several years after ACA implementation, the uninsured proportion had dropped to 10.4%, a dramatic improvement. Additionally, not all states expanded Medicaid, but in those that did, affordable preventive care led to substantially higher cancer-detection rates.

The Health Affairs study elegantly took the analysis a few steps further. Prior to 2014, many Americans from age 60-64, what this study terms the “near-elderly,” found themselves with no affordable health insurance and no way to pay for preventive tests. The result: At age 65, the age of Medicare eligibility, there was a significant increase in the detection of cancers compared to people in their early 60s. In other words, once a person qualified for Medicare, they would start doing the preventive health screenings their doctor had been recommending for the preceding few years.

This new study looked at what happened to the folks from 60-64 after ACA implementation. Forty-five percent of the jump in cancer detection at age 65 was eliminated because the cancers were found before the folks turned 65; they did not have to wait for Medicare to seek care. Most importantly, over two-thirds of the cancers found in this population were in the early or middle stages and more receptive to treatment.

Anyone with health insurance sometimes schedules health care around deductibles or the effective date of a new health plan or other financial considerations. Health care can be expensive, and we Americans are not stupid. The ACA — by expanding Medicaid for lower-income people, offering subsidies for others, and making sure that policies cover preventive health measures in an affordable manner — gave Americans the chance to have consistent quality insurance and health care.

But there was a temporary dark side to this implementation. I heard from more than one Arkansas doctor that some patients put off care once they heard that in 2014 health insurance might be available. The result: For a year or two before the ACA began, some people with cancers and other undiagnosed ailments postponed seeking treatment until health insurance was available. Unfortunately, the disease process was further along.

What does this have to do with the future? This study in Health Affairs demonstrates that American families will consider finances when it comes to seeking care, and the finances can produce missed opportunities for health.

If we have a system of health insurance in which families or individuals lose coverage and restart it sometime later, these people will rationally not seek care during those gaps and will put themselves or their family at risk of having more advanced disease when they are able to resume health insurance. American patients, doctors and hospitals do best in a system in which families can rely on quality health insurance with no interruption in coverage.

Health care is a huge chunk of the American economy and the lives of our families. There is always need for improvement. But we must not forget this reality: Gaps in health-insurance coverage produce gaps in health services, and the result is more unnecessary suffering and interference with work and family.