Implications of the initial Braidwood v. Becerra ruling for colorectal cancer outcomes: a modeling study

Area of Science:

• Health policy
• Preventive medicine
• Cancer epidemiology

Background:

• The Affordable Care Act (ACA) eliminated patient cost-sharing for services recommended by the United States Preventive Services Task Force (USPSTF).
• A court ruling (Braidwood Management v. Becerra) threatened to reinstate cost-sharing for USPSTF-recommended services, impacting over 150 million individuals.
• This ruling specifically targeted colorectal cancer (CRC) screening for ages 45-49 and polyp removal during colonoscopies.

Purpose of the Study:

• To simulate the potential impact of reinstated cost-sharing on CRC outcomes.
• To assess the effects of decreased screening participation on CRC incidence and mortality.
• To analyze the economic implications of changes in screening rates and diagnoses.

Main Methods:

• Utilized the MISCAN-Colon model for simulation.
• Incorporated trends in early-onset CRC.
• Assumed a decline in screening participation rates.

Main Results:

• An 8-percentage-point decrease in screening participation could lead to a 5.1% increase in CRC incidence and a 9.1% rise in CRC mortality.
• Slightly lower healthcare costs were projected due to increased patient cost-sharing.
• Larger reductions in screening participation were associated with increased incidence and delayed diagnoses, potentially raising overall costs.

Conclusions:

• Reinstating cost-sharing for preventive services, particularly CRC screening, could have significant adverse effects on public health outcomes.
• Decreased screening participation due to cost barriers may exacerbate the burden of colorectal cancer.
• Policy decisions regarding cost-sharing for preventive care have substantial implications for cancer incidence, mortality, and healthcare economics.