Association for Public Policy Analysis & Management

The Patient Protection and Affordable Care Act of 2010 (ACA) sought to increase use of preventive services by eliminating cost sharing to consumers, making eligible services exempt from plan deductibles, copayments, and coinsurance. However, consumer understanding of health insurance terminology and benefit design is often poor; thus, this incentive to increase utilization of preventive services may not be understood or ignored in the face of high deductibles. Also, consumers may not obtain preventive services (e.g., cancer screenings) if they perceive that the cost for any subsequent treatment will be too high. In this study, we address whether high deductible health plan enrollment is associated with a difference in the use of preventive services after exempting them from cost sharing using a quasi-experimental approach, employing both parametric and semi-parametric difference-in-differences. Our results suggest that the elimination of cost sharing for preventive services did not result in a differential response by high deductible health plan status. We do, however, find that the policy was seemingly ineffective at reducing out-of-pocket costs for consumers using eligible preventive services. If use of preventive services is less than optimal and costs are a barrier, then creating greater awareness of the benefit among consumers and streamlining coding requirements across insurers are potential solutions.