An Ounce of Prevention

The projected benefits of the (ACA) are based on several central tenants inherent to the law, such as the expected improvement in utilization of cost-saving preventative medicine when access to insurance is increased and cost to patients is decreased. The effectiveness of the ACA will be an important talking point as we near the 2016 presidential election, yet little data exists on how the ACA has affected access to preventative health care since major components of the law were implemented.

Guidelines for inclusion of services within private insurance, via insurance exchanges, were created by the ACA to ensure that preventive care is available to all individuals. Public insurers, such as and , have a precedent of providing these interventions at low cost to patients. Private insurers, however, have not been historically subject to the same regulations. As these regulations are applied to private insurers entering marketplace exchanges, reformers hope that those who hold private insurance will now have access to basic preventative services.

Data from 2011 and 2012 on utilization of nine preventive health services covered by the ACA were collected and analyzed. The services were chosen for their inclusion in both ACA regulations and the CDC’s National Health Interview Survey and include screenings for blood pressure, breast cancer, cervical cancer, cholesterol, colon cancer, diabetes, diet counseling, hepatitis A vaccination, and hepatitis B vaccination.

Results showed that individuals with insurance of any kind received higher rates of preventative services than uninsured individuals along all variables measured. This was especially true of services were associated with higher co-pays (e.g. colorectal cancer screening). The data comparing those with private versus public insurance were less clear, with public insurers providing higher rates of screening for all services except breast cancer, cervical cancer, and hepatitis B vaccination.

As implementation of the ACA continues, politicians and patient advocates will benefit from having a baseline assessment of preventative service utilization to compare with future generations.  Nevertheless, future assessments could do a great service to the medical community by collecting additional demographic data, including ethnicity and other socioeconomic indicators, as this information will guide policy and public health advocates toward reforms responsive to the needs of specific patient communities.

commentary by Orlando Sola

Abstract

Preventive services are available for nine of the ten leading causes of death in the United States. The Affordable Care Act (ACA) has reduced cost as a barrier to care by expanding access to insurance and requiring many health plans to cover certain recommended preventive services without copayments or deductibles. To establish a baseline for the receipt of these services for monitoring the effects of the law after 2012, CDC analyzed responses from persons aged ?18 years in the National Health Interview Survey (NHIS) for the years 2011 and 2012 combined. NHIS is an in-person interview administered annually to a nationally representative sample of the noninstitutionalized, U.S. civilian population. This report summarizes the findings for nine preventive services covered by the ACA. Having health insurance or a higher income was associated with higher rates of receiving these services, affirming findings of previous studies. Securing health insurance coverage might be an important way to increase receipt of clinical preventive services, but insurance coverage is not sufficient to ensure that everyone is offered or uses clinical services proven to prevent disease. Greater awareness of ACA provisions among the public, public health professionals, partners, and health care providers might help increase the receipt of recommended services.

Fox, JB and Shaw, FE. MMWR. 2015 ;64 (27): 738-42. PMID: 26182191