Impacts of the Affordable Care Act on Receipt of Women's Preventive Services in Community Health Centers in Medicaid Expansion and Nonexpansion States

Brigit Hatch,Megan Hoopes,Teresa Schmidt,Blair G Darney,Erika Cottrell,Anna Rose Templeton,Miguel Marino

doi:10.1016/j.whi.2020.08.011

Brigit Hatch, Megan Hoopes + Show 5 more

Open Access

https://doi.org/10.1016/j.whi.2020.08.011

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Abstract

Background:The Affordable Care Act (ACA) increased health insurance coverage throughout the United States and improved care delivery for some services. We assess whether ACA implementation and Medicaid expansion were followed by greater receipt of recommended preventive services among women and girls in a large network of community health centers.Methods:Using electronic health record data from 354 community health centers in 14 states (10 expansion, 4 non-expansion), we used generalized estimating equations and difference-in-difference methods to compare receipt of six recommended preventive services (cervical cancer screening, human papilloma virus vaccination, chlamydia screening, influenza vaccination, human immunodeficiency virus screening, and blood pressure screening) among active female patients ages 11 to 65 (N = 711,121) before and after ACA implementation and between states that expanded versus did not expand Medicaid.Results:Except for blood pressure screening, receipt of all examined preventive services increased after ACA implementation in both Medicaid expansion and nonexpansion states. Influenza vaccination and blood pressure screening increased more in expansion states (adjusted absolute prevalence difference-in-difference, 1.55; 95% confidence interval, 0.51–2.60; and 1.98; 95% confidence interval, 0.91–3.05, respectively). Chlamydia screening increased more in nonexpansion states (adjusted absolute prevalence difference-in-difference: −4.21; 95% confidence interval, −6.98 to −1.45). Increases in cervical cancer screening, human immunodeficiency virus screening, and human papilloma virus vaccination did not differ significantly between expansion and nonexpansion states.Conclusions:Among female patients at community health centers, receipt of recommended preventive care improved after ACA implementation in both Medicaid expansion and nonexpansion states, although the overall rates remained low. Continued support is needed to overcome barriers to preventive care in this population.

Highlights

The Affordable Care Act (ACA) increased health insurance coverage throughout the United States and improved care delivery for some services
Among women and girls receiving care in community health center (CHC), receipt of five of six key preventive services increased after implementation of the ACA in both Medicaid expansion and nonexpansion states. (Blood pressure screening did not increase after ACA implementation among Medicaid nonexpansion states but was already very high before the ACA and remained high in both expansion and nonexpansion groups.) These findings are consistent with previous literature that suggests other preventive services like mammography and colorectal cancer screening increased overall after the implementation of the ACA (Alharbi et al, 2019; Huguet et al, 2019; Sun et al, 2018)
Gains in preventive service delivery have previously been attributed to broad insurance expansion (Huguet et al, 2017), development of Accountable Care Organizations with incentivized focus on quality metrics (Meyer et al, 2017), and additional resources for safety net health centers through federal grants and increased health insurance revenue (Han et al, 2017; Huguet et al, 2019)

Summary

Introduction

The Affordable Care Act (ACA) increased health insurance coverage throughout the United States and improved care delivery for some services. We assess whether ACA implementation and Medicaid expansion were followed by greater receipt of recommended preventive services among women and girls in a large network of community health centers. Methods: Using electronic health record data from 354 community health centers in 14 states (10 expansion, 4 nonexpansion), we used generalized estimating equations and difference-in-difference methods to compare receipt of six recommended preventive services (cervical cancer screening, human papilloma virus vaccination, chlamydia screening, influenza vaccination, human immunodeficiency virus screening, and blood pressure screening) among active female patients ages 11 to 65 (N 1⁄4 711,121) before and after ACA implementation and between states that expanded versus did not expand Medicaid. Conclusions: Among female patients at community health centers, receipt of recommended preventive care improved after ACA implementation in both Medicaid expansion and nonexpansion states, the overall rates remained low.

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Conclusion