Public Insurance is not a Barrier to Colorectal Cancer Screening

Introduction: The Affordable Care Act (ACA) provided states and Washington D.C. the option to expand Medicaid coverage to beneficiaries with incomes up to 138% of the Federal Poverty Line. Expanded coverage went into effect in Washington D.C. on January 1, 2014. Insurance coverage, however, does not necessarily equate to access. This holds especially true for low-income, public insurance such as Medicaid as fewer providers accept this insurance. Colorectal cancer (CRC) screening is important for detecting precancerous colonic lesions and preventing progression to future disease. This study compares the rate of CRC screening in appropriately aged individuals on public insurance and in their privately insured counterparts. Methods: Individuals attending an August 2015 health exposition sponsored by the Rodham Institute completed an anonymous health survey. The exposition was hosted at a community center in an urban location with a historically African American predominant population. The survey included questions on demographic information, insurance information, access to primary care, and CRC screening. Data from the survey was analyzed in a Microsoft Excel database. Insurance types were classified as public insurance (Medicaid and other District government sponsored programs) or private insurance (Blue Cross, Aetna, etc.). Surveys were excluded if specific questions of interest were left unanswered. Statistical analysis was performed using Fisher’s exact test, with significance set at P\u3c0.05. The study was approved by the university’s institutional review board. Results: There were 102 participants with an average age of 42.4. Ninety-three (91.2%) identified as African American. Fifty-six (54.9%) respondents had public insurance and 28 (27.4%) had private insurance. Twenty-nine (51.8%) of those with public insurance enrolled within the past 18 months, 25 (44.6%) enrolled earlier, and 2 participants did not respond. Given the predominantly African American population and the recent CRC screening recommendations advising this population to begin screening at age 45, a subgroup analysis was conducted in survey participants 45 years and older. Of the thirty-nine participants 45 years-old and above, 22 (56.4%) had public insurance and 17 (43.6%) had private insurance. Thirteen (59%) publically insured responders received CRC screening while 12 (70.5%) responders on private insurance had received CRC screening (p=0.518). Conclusions: This study showed that public insurance was not associated with significantly decreased rates of CRC screening when compared with respondents with private insurance. In this study at a Washington, D.C. health expo, a majority of respondents with public insurance had acquired it in the previous 18 months, correlating temporally with ACA Medicaid expansion. While there has been concern that, despite having insurance, public insureds may have difficulty accessing health care, this did not appear to be a barrier to CRC screening in this population. Limitations of our study include a small sample size and a predominantly African American population. Additionally, the District of Columbia had, prior to Medicaid expansion, a greater-than-typical safety net insurance program, so referral patterns and provider acceptance may already have been established

Patients with High Educational Attainment Are More Likely to Have Screening for Hepatitis C Virus

Introduction Approximately 3 million people in the United States are afflicted with chronic Hepatitis C virus (HCV) infection. Infection is most prevalent in patients born between 1945-1965, and the African American community is disproportionately affected. A screening test is available and recommended, but many patients with HCV infection are unaware that they are infected. There are many obstacles to obtaining preventative care, and a lower level of education has been associated with decreased access. This study evaluated the impact of education level on access to HCV screening in a historically underserved community. Methods Individuals attending a health exposition in August 2015 sponsored by the Rodham Institute completed an anonymous survey. The exposition was hosted in an urban setting with a predominantly African-American population. The survey included questions regarding demographics, access to care, insurance status, and HCV screening and awareness. Responses were excluded if education level was not specified or any questions went unanswered. Statistical analysis was performed using Fisher’s exact test, with significance set at p \u3c 0.05. Results There were 102 respondents. Ninety-two (90.2%) completed the HCV screening and education questions and were included in the study. Thirty (32.6%) had a college degree; 19 (63.3%) of them had discussed HCV screening with their primary care providers. Sixty-two (68.8%) had high school education or less and 24 (38.7%) discussed HCV screening with their doctor (p\u3c0.0440). There were 27 respondents born between 1945 and 1965. Twelve (44.4%) had a college education and 15 (55.6%) had less. Within this cohort, 10 (83.3%) college-educated respondents and five (33.3%) of the others had discussed HCV screening with the primary doctor (p\u3c0.0185). Discussion The African-American population is disproportionately affected by HCV, and many of these patients are unaware of their infection status. Our study found that in this underserved community, those with higher education were more likely to discuss HCV screening with their primary care provider than those without. Interestingly, this trend was more pronounced among the 1945-1965 birth cohort, in whom universal screening is recommended. Although our study may be limited by a small sample size, it highlights that access to higher education may be associated with increased knowledge of HCV and availability of screening. It is imperative that physicians continue to discuss HCV screening with all at-risk patients in order to spread awareness and reduce morbidity. The study demonstrates that education is an important social determinant of health

Youth Has its Disadvantages -- Younger Consumers are Less Likely to Understand Their Health Insurance

Introduction: Implementation of the Affordable Care Act provided Approximately 23 million people acquired health insurance as a result of Affordable Care Act. While access to insurance may have increased, applicants have been faced with a wide variety of choices of insurance products, in some cases more than they would have had with employer-based plans. Consumers faced with acronyms such as HMO, PPO, HDHPs, and POS are asked to choose coverage while they may have little understanding of what these terms mean and how they differ. Young people typically have had little exposure to insurance plans in the past and may be at a greater disadvantage in choosing a policy. This study examined understanding of one’s health insurance plan as a function of age. Methods: Individuals attending a Washington, DC health exposition sponsored by the Rodham Institute completed an anonymous survey in August 2015. The exposition was hosted in an urban, medically underserved setting where the population has historically been predominantly African American; currently 92% of residents identify as such. The survey included questions on demographic information, insurance status, as well as questions related to obtaining insurance. Responses were excluded if questions regarding age or insurance knowledge were unanswered. The university institutional review board approved the study. Statistical analysis was performed using Fisher’s exact test, with significance set at p\u3c0.05. Results: There were 96 responses analyzed. Twenty eight (29.2%) individuals were over the age of 50 and 68 (70.8%) were younger. Twenty (29.4%) of the younger respondents reported understanding how their insurance worked. In the older age group, 26 (92.8%) understood their health insurance. Those over the age of 50 were more likely to have a firm understanding of their medical insurance plan compared to those under the age of 50 (p=0.0001). Among 28 college educated respondents, 23 (82.1%) understood their insurance. Fifty one (76.1%) of 67 respondents with less education had such an understanding. There was no difference with respect to education level (p=0.5973). Discussion: Our study revealed that younger customers are three times less likely to endorse an understanding of how their health insurance works. While the Affordable Care Act has expanded access to health insurance, many face a wider variety of options than they may have had prior to the passage of reforms. Because younger people have had less experience (or no experience) with health insurance in the past, they would benefit from educational resources to inform their choices. A disadvantageous selection of plan, deductible, and coinsurance may make financial concerns a greater component of medical decision making