Abstract
Background
The Affordable Care Act (ACA) requires non-grandfathered private insurance plans, starting with plan years on or after September 23rd, 2010, to provide certain preventive care services without any cost sharing in the form of deductibles, copayments or co-insurance. This requirement may affect racial and ethnic disparities in preventive care as it provides the largest copay reduction in preventive care.
Objectives
We ask whether the ACA’s free preventive care benefits are associated with a reduction in racial and ethnic disparities in the utilization of four preventive services: cholesterol screenings, colonoscopies, mammograms, and Pap smears.
Methods
We use a data set of over 6000 individuals from the 2009, 2010, and 2013 Medical Expenditure Panel Surveys (MEPS). We restrict our data set only to individuals who are old enough to be eligible for each preventive service. Our difference-in-differences logistic regression model classifies privately insured Hispanics, African Americans, and Asians as the treatment groups and 2013 as the after-policy year. Our control group consists of non-Hispanic whites on Medicaid as this program already covered preventive care services for free or at a low cost before the ACA.
Results
After controlling for income, education, marital status, preferred interview language, self-reported health status, employment, having a usual source of care, age and gender, we find that the ACA is associated with increases in the probability of the median, privately insured Hispanic person to get a colonoscopy by 3.6% and a mammogram by 3.1%, compared to a non-Hispanic white person on Medicaid. Similarly, we find that the median, privately insured African American person’s probability of receiving these two preventive services improved by 2.3 and 2.4% compared to a non-Hispanic white person on Medicaid. We do not find any significant improvements for any racial or ethnic group for cholesterol screenings or Pap smears. Furthermore, our results do not indicate any significant changes for Asians compared to non-Hispanic whites in utilizing the four preventive services. These reductions in racial/ethnic disparities are robust to reconfigurations of time periods, previous diagnosis, and residential status.
Conclusions
Early effects of the ACA’s provision of free preventive care are significant for Hispanics and African Americans. Further research is needed for the later years as more individuals became aware of these benefits.
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Notes
This report is available at http://www.rwjf.org/content/dam/farm/reports/reports/2007/rwjf13325.
Additional information is available at http://kff.org/health-reform/fact-sheet/preventive-services-covered-by-private-health-plans/.
3Additional information is available at http://kff.org/health-reform/fact-sheet/preventive-services-covered-by-private-health-plans/nefits-2013_section_13.pdf.
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Cagdas Agirdas and Jordan G. Holding have made substantial contributions to the conception and planning of the work that led to the manuscript, analysis and interpretation of the data, empirical analysis, literature review, and the drafting and revisions of the manuscript.
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Authors of this manuscript certify that no funding has been received for the conduct of this study and/or preparation of this manuscript.
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Neither Cagdas Agirdas or Jordan G. Holding have any conflict of interests.
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Agirdas, C., Holding, J.G. Effects of the ACA on Preventive Care Disparities. Appl Health Econ Health Policy 16, 859–869 (2018). https://doi.org/10.1007/s40258-018-0423-5
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DOI: https://doi.org/10.1007/s40258-018-0423-5