This past week, I saw a patient in her 60s in my office for a routine visit. When I told her that it was time for her mammogram, she told me she’d been thinking of skipping it this year because money is tight and because she was not sure she could afford the co-pay. Without needing to check online or call her insurance, I had the privilege of telling her that she would have no co-pay because all preventive screenings are now free for patients on Medicare. She left smiling with her mammogram slip in her pocket.
In the years I have spent caring for uninsured and underinsured patients, one of the saddest things I have seen has been the women who come in with a large breast lump that they know and I soon confirm is a cancer. These women have often known the lump was there for months or even longer. They are not dumb, and many have lost a mother or a sister or an aunt to breast cancer and are well aware of the need for screening and early diagnosis. What stops them from coming in has not been a lack of knowledge about cancer, it has been a lack of access to affordable health care because they are uninsured.
In 2010, approximately 40,000 women died from breast cancer in the U.S. We don’t have the technology yet to prevent all of those deaths, but regular screening mammograms could have prevented about 8000 of them. 4200 women died from cervical cancer in 2010. These deaths should be almost entirely preventable with regular pap smears, another preventive service now covered without cost for women. 25,000 women died from colon cancer, of which about 60% (15,000) could have been prevented with colon cancer screening.
The Affordable Care Act marks a fundamental change in how this country approaches health care. For the first time, we are saying as a society that everyone has a right to health and health care. The law also puts a real focus on access to preventive health care. As of September 2010, all new insurance plans must cover preventive services without a co-pay. As of January 1st, 2011, Medicare does the same. We now have not only the medical science to prevent these deaths; we have legislation that requires insurance companies to make these services affordable. But there is one thing more that is urgently needed. Too many people remain confused about their benefits under the ACA, like my patient who would have skipped her mammogram because of a non-existent co-pay. If we are to obtain the full benefits of the new law in terms of preventing unnecessary disability and death, we all need to understand that these services are free and that they are critical to our health as a society. Beyond that, we all need to make sure that our family members, our neighbors, our friends, and our co-workers understand their new benefits so that fewer women (and men) need to die deaths we could have and should have prevented.