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Establishing Impacts of the Affordable Care Act on Women's Access to Preventive Services
The benefits of preventive health services for women are well established, but most services are underutilized. Studies have shown that while many factors contribute to the use of preventive services, insurance coverage and out of pocket costs are particularly important predictors. The Affordable Care Act (ACA) provides a number of opportunities to increase access to preventive care for women. Uninsured women who gain coverage under the ACA Medicaid expansion or through the exchanges are expected to face fewer barriers to accessing preventive services. In addition, privately insured women stand to benefit as health plans comply with new requirements to cover recommended services without cost-sharing. This paper explores pre-reform service use and cost-sharing burdens for groups of women likely to gain coverage under the ACA and examines the early impacts of provisions aimed at improving coverage for the privately insured.
Using data from the Medical Expenditure Panel Survey (MEPS), we identify gaps in the receipt of recommended preventive services for uninsured women prior to the ACA and predict the likely effects of ACA coverage expansions on service use. We examine routine checkups along with pap tests, breast exams, blood pressure and cholesterol checks, diet, exercise and smoking cessation advice, and flu vaccines. We find that low-income uninsured women could see increases of at least 10 percentage points in the likelihood of receiving each of the studied services if they gained Medicaid coverage. Similarly, covering uninsured women with moderate incomes with private coverage could result in significant increases in receipt of preventive care.
In an effort to understand the implications of ACA provisions requiring private insurers to eliminate cost-sharing for recommended preventive services, we also provide the first estimates based on national data of the pre-reform cost sharing burdens for general checkups, prenatal visits and contraceptive prescriptions. Using the MEPS individual event files, we find that low-income privately insured women face significant out-of-pocket costs for preventive care. For example, women with employer coverage and incomes below 150 percent of the FPL who use prescription contraception spend approximately 4 percent of their household incomes on cost-sharing for these prescriptions.
Our initial results indicate that covering uninsured women under the ACA will increase receipt of preventive services and that eliminating cost sharing for the privately insured will substantially reduce the financial burden for low-income women seeking these services.
With the recently released 2011 MEPS data, we will also explore the early impacts of the provisions implemented in September 2010 requiring private insurers to cover recommended preventive services without cost-sharing. We expect to see increases in use and reduced cost-sharing for privately insured women beginning in the last quarter of 2010 and continuing throughout 2011. In order to ascribe any observed patterns to the ACA, we will use a difference-in-differences approach to compare trends in service use from 2007-2011 for the privately insured to those for the publicly insured, a group that is largely exempt from the preventive care provisions of the ACA.