Office of Epidemiology and Research, Division of Research

Advancing Applied MCH Research

(SDAS) Establishing Potential and Early Impacts of the Affordable Care Act on Women's Access to Preventive Services.

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Project Number: R40 MC 25690
Grantee: Urban Institute
Department/Center: Health Policy Center
Project Date: 02/01/2013

Final Report


Principal Investigator

Stacey McMorrow, Ph.D.
Research Associate
2100 M Street, NW
Washington, DC  20037-1207
Phone: 202-261-5307


  • Women/Maternal


The proposed project will characterize the potential of the Affordable Care Act (ACA) to improve access to and affordability of preventive and other beneficial health services for women of reproductive age. We expect that expansions of Medicaid coverage, the availability of federal subsidies to purchase insurance in exchanges, and a mandate for private insurers to cover recommended preventive services will have sizable impacts on the health and well-being of women during their reproductive years. Uninsured women who gain coverage under the ACA Medicaid expansion or through the exchanges are expected to face fewer barriers to accessing preventive services under reform. In addition, privately insured women, particularly those with low-incomes or less generous coverage, stand to benefit from the ACA as health plans expand coverage and reduce cost-sharing requirements for recommended preventive care. Women currently covered by Medicaid and those with higher incomes are expected to see fewer access improvements under reform. Using data from the Medical Expenditure Panel Survey (MEPS), we will identify gaps in the receipt of recommended preventive services for women, including screenings for cervical cancer and sexually transmitted infections as well as diet and tobacco use counseling, prior to the ACA. We will also quantify cost sharing burdens for these services, as well as for contraceptive procedures and prescriptions in the years leading up to reform. Our analysis will focus on those groups most likely to benefit from the coverage and cost-sharing provisions of the ACA, including low-income uninsured women who may become eligible for Medicaid or subsidies to purchase exchange coverage under reform. By focusing on the service gaps and cost-sharing burdens for these groups prior to reform, our results will identify the potential for the ACA to improve preventive care for women and the possible consequences of less than full implementation of the Medicaid expansion. In addition to establishing these pre-reform measures of service use and cost-sharing, we will estimate the early impacts of the ACA provisions implemented in September 2010 in which many private insurers were required to provide coverage for certain preventive services without any cost sharing. Using data from the 2010 and 2011 MEPS, we will describe changes in preventive service use and cost-sharing burdens for women during the early implementation of these provisions. 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 observed increases in the use of preventive services by the privately insured to the provisions of the ACA, however, 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. This study directly addresses MCHB strategic research issue #IV: Promoting the healthy development of MCH populations. The benefits of preventive health care services for women of reproductive age are well established and this study will quantify the potential for the ACA to reduce barriers to receipt of these services. It will also identify the women for whom access problems may persist under reform and for whom additional interventions may be necessary.




Access to Health Care, Preconception Health, Screening, Health Care Costs, Health Care Utilization, Primary Care, Insurance Coverage

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