Family Planning Confidential: A Qualitative Research Study on the Implications of the Affordable Care Act

Abstract

PurposeA cornerstone of the Title X program is guaranteed access to confidential family planning services regardless of patients’ ability to pay. This is particularly important for adolescents and young adults. The Patient Protection and Affordable Care Act (ACA) expanded health insurance access for thousands of individuals. But, billing third-party payers for family planning services can result in the generation of explanations of benefits and other communications to the policy holder that may compromise confidentiality for covered dependents. MethodsThe research team facilitated 12 focus groups with 62 Title X clients in 5 states and conducted interviews with 91 health center key informants in 10 states. Transcripts were coded using NVivo version 10.0. Researchers used deductive coding and grounded theory to search for themes. ResultsClients expressed confusion about the difference between confidential services from their health center versus confidential communications from their health insurance plan. Health center staff also highlighted confidentiality issues that may arise from ACA insurance expansion and revealed that clients overall do not understand how health insurance works, particularly younger clients and those that were newly covered under the ACA. ConclusionsMany Title X supported health centers will continue not to bill insurance if there are concerns regarding confidentiality, especially with their adolescent and young adult clients. Despite additional revenue sources that have emerged since the passage of the ACA, Title X funding may remain critical for clients who need safe, affordable, and confidential care.