The benefits of preventive health care services for women are well established, but rates of recommended service use vary considerably. 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, with uninsured women at least half as likely to seek preventive services compared with women with insurance coverage. 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 under reform. In addition, privately insured women, particularly those with low-incomes or less generous coverage, stand to benefit as health plans comply with new requirements to cover certain preventive services without cost-sharing. This paper considers the potential effects of the ACA on receipt of preventive care for women by exploring pre-reform service use and cost-sharing burdens for groups of women likely to benefit from the coverage and cost-sharing provisions of the ACA. 

Using data from the Medical Expenditure Panel Survey (MEPS), we identify gaps in the receipt of recommended preventive services for women prior to the ACA and predict the likely effects of ACA coverage expansion on service use. We examine pap tests, breast exams, blood pressure and cholesterol checks, diet, exercise and smoking cessation advice, and flu vaccines. We find, for example, that women with incomes below 400 percent of the federal poverty level are 8 percentage points less likely to receive a pap test and 15 percentage points less likely to receive a breast exam than those with higher incomes. We also predict that the proportion of women with incomes less than 138 percent of the FPL receiving a pap test would increase by 5 percentage points if the uninsured gained Medicaid coverage. Covering uninsured women with incomes between 138 and 399 percent of the FPL with private coverage would improve preventive care receipt among this population as well. 

We will also quantify pre-reform cost sharing burdens for several categories of preventive services in an effort to understand the likely impact of the ACA provisions requiring private insurers to cover these services without cost-sharing. Using the MEPS individual event files, we will examine out-of-pocket spending for general preventive care visits, prenatal care, and contraceptive visits and prescriptions. We will consider how cost-sharing burdens vary by income and for those with different types of private coverage. This analysis will identify which women and services are most likely to be affected by the ACA private prevention provisions. 

Our preliminary results indicate that covering uninsured women under the ACA will increase receipt of preventive services, but the extent of the increase will depend on state implementation of the Medicaid expansion and the success of exchanges in expanding coverage among higher income individuals. Determining the pre-reform cost-sharing burdens faced by privately insured women will have important implications for future analysis of the ACA’s effects on preventive care.