The Affordable Care Act and HPV Vaccine Take-Up

Human papillomavirus (HPV) is the most common sexually-transmitted infection in the United States. Though vaccines targeting HPV have been available since 2006 and are recommended by the CDC for all women through age 26, vaccination rates remain low.  The recommended three doses cost approximately $390, representing a significant expense to uninsured women.  Further, lack of awareness may exacerbate low vaccination rates.  Our estimates from the National Health Interview Survey (NHIS) imply that while 84% of non-Hispanic white and 69% of non-Hispanic black women are aware of the vaccine, awareness was lower among other groups, with only 56 and 55% of Hispanic and Asian women reporting knowledge of the vaccine, respectively.

After documenting rates of awareness of the HPV vaccine and vaccination rates using data from NHIS 2008-2012, we estimate the effect of the 2010 federal implementation of the extended dependent coverage provision of the Affordable Care Act (ACA) using a difference-in-difference approach.  The provision, which required plans to insure adult children up to age 26 under their parents’ plans, has the potential to increase vaccine take-up by reducing out-of-pocket costs and increasing access to care.  Recent estimates suggest the provision increased the rate of health insurance coverage among 19-25 year olds by nearly 7 percentage points for all race/ethnic groups.  Our analysis estimates the effect of the September 2010 policy implementation on outcomes for the treatment group (women aged 19-25) in comparison with a control group (women aged 18 or 26).

Though implementation of the policy did not measurably affect awareness of the vaccine, young women aged 19-25 were more likely to have received the vaccine after the provision took effect.  For example, the likelihood of having at least one dose of the vaccine increased by 7.5 percentage points (p<0.05) for young women aged 19-25 relative to the control group.  When results are stratified by race/ethnicity, we find that vaccine take-up among 19-25 year olds increased significantly only for non-Hispanic white and black women; the likelihood of receiving at least one dose of the vaccine increased by 9.4 (p<0.05) and 14.8 percentage points (p<0.01) respectively, relative to the control group.  In future work, we will also use data on HPV prevalence among 14 to 26 year old women from the 2006-2012 National Health and Nutrition Examination Survey to determine whether prevalence of vaccine-targeted HPV strains decreased after implementation of the dependent coverage legislation.  

These findings suggest that by increasing access to care and improving the affordability of the HPV vaccine, the extended dependent coverage provision may have increased HPV vaccine take-up among young women aged 19-25.  However, Hispanic and Asian women were not significantly more likely to receive the vaccine as a result of the provision.  Although progress in increasing vaccine take-up is promising, policies aimed at increasing knowledge of the vaccine may be needed to further address racial disparities in take-up.