Preventive Services Essay – Online Nursing Essays

January 11, 2022 HP-2022-01 Access to Preventive Services without Cost-Sharing: Evidence from the Affordable Care Act Research examining the impact of the Affordable Care Act suggests that millions of individuals have benefitted from increased access to care and coverage of clinical preventive services without cost-sharing. KEY POINTS • • • • • The Affordable Care Act (ACA) substantially increased access to care and coverage of preventive services without cost-sharing for millions of Americans. Many preventive services including vaccinations, well-child visits, screening for HIV and sexually transmitted infections, HIV pre-exposure prophylaxis, contraception, and cancer screening are required to be covered by most group and individual health plans and for many Medicaid beneficiaries without cost-sharing. Expanded access to recommended preventive services resulted from increases in the number of people covered through private health insurance and Medicaid expansion under the ACA. Analysis of recent data indicates that more than 150 million people with private insurance – including 58 million women and 37 million children – currently can receive preventive services without cost-sharing under the ACA, along with approximately 20 million Medicaid adult expansion enrollees and 61 million Medicare beneficiaries that can benefit from the ACA’s preventive services provisions. Evidence from studies examining the impact of the ACA indicate increased colon cancer screening, vaccinations, use of contraception, and chronic disease screening. BACKGROUND Preventive services can help people avoid acute illness, identify and treat chronic conditions, prevent cancer or lead to earlier detection, and improve health. The Affordable Care Act (ACA) reduced financial barriers to accessing preventive services by requiring that most private health plans cover certain recommended preventive services without cost-sharing. This requirement became effective for new health coverage beginning on or after September 23, 2010, except for a requirement concerning women’s preventive services, which became effective for plan years beginning on or after August 1, 2012. 1 Under the ACA, in most instances group health plans and individual health coverage plans cannot charge a patient a copayment, co-insurance, or deductible for these services when they are delivered by an in-network provider. * One exception are so-called “grandfathered” plans, which are plans that were in existence prior to 2010 and are allowed to continue offering benefit designs other than those generally required by the ACA. By eliminating cost-sharing for these services, the ACA was designed to increase access and use of preventive care, especially among individuals for whom affordability was a key barrier. This issue brief summarizes the ACA’s preventive services provisions for private health coverage, Medicare, and Medicaid; provides updated estimates of the number of people benefiting from these provisions nationally; and examines evidence on trends in utilization of preventive services and outcomes since the ACA’s preventive services coverage requirements went into effect. POLICY OVERVIEW Private Health Coverage Under the ACA, most private insurance plans are required to cover four categories of preventive services innetwork without cost-sharing, including: 1. evidence-based preventive services that have in effect a rating of A or B in the current recommendations of the U.S. Preventive Services Task Force (USPSTF), which indicates moderate to high certainty that the net benefits of those services are moderate to substantial; 1 2. routine vaccines for adults and children that have in effect a recommendation from the Advisory Committee on Immunization Practices (ACIP) and which has been adopted by the Director of the Centers for Disease Control and Prevention (CDC);2 3. evidence-informed preventive services for infants, children, and adolescents provided for in comprehensive guidelines supported by the Health Resources and Services Administration (HRSA); †,3 and 4. preventive care and screenings for women, other than those that have in effect a rating of A or B in the current recommendations of the USPSTF, that are provided for in comprehensive guidelines supported by HRSA. 4 These requirements do not apply to grandfathered plans, which are plans that existed on March 23, 2010, before the law was enacted, that meet certain requirements, and that are exempt from certain provisions of the ACA. ‡ The range of preventive services covered without cost-sharing includes services such as alcohol misuse screening and counseling, blood pressure screening, depression screening, immunizations, and obesity screening and counseling. Certain covered preventive services recommended by the USPSTF are specific to people in certain age groups or individuals at increased risk; for example, screening for latent tuberculosis in populations at increased risk of infection, and colorectal cancer screening for adults aged 45 to 75. 5,6,7 The USPSTF defers to the ACIP on recommendations concerning the use of vaccines. § _______________________ † The guidelines implemented by HRSA are commonly referred to as Bright Futures and the Women’s Preventive Services Guidelines. ‡ These requirements also do not apply to coverage of certain services when a religious exemption applies. § The Centers for Disease Control and Prevention (CDC) sets the U.S. adult and childhood immunization schedules based on recommendations from the ACIP. JANUARY 2022 ISSUE BRIEF 2 Most health plans also generally must cover a set of preventive services for children without cost-sharing (i.e., those plans that are not grandfathered as discussed above) including those providing coverage in the group, individual, and Medicaid markets. 8 Preventive services benefits for children include, but are not limited to, alcohol, tobacco, and drug use assessments for adolescents; universal newborn hearing screening; developmental and autism screening for children at 18 and 24 months; bilirubin concentration screening for newborns; blood pressure screening for children ages 0 to 17 years; developmental screening for children under age 3; and routine immunization for children from birth to age 18 (doses, recommended ages, and recommended populations vary). In most instances, non-grandfathered group and individual health coverage plans are required to cover certain preventive benefits for women, including well-woman visits, screening and counseling for domestic violence, U.S. Food and Drug Administration (FDA)-approved contraceptive methods, and other services specified in the Women’s Preventive Services Guidelines, which initially went into effect August 2012. 9 These guidelines are updated periodically to reflect the latest evidence-based recommendations including, for example, a recommendation that adolescent and adult women have access to the full range of FDA-approved contraceptive products, effective family planning practices, and sterilization procedures for women to prevent unintended pregnancy and improve health outcomes. Estimated Population Size with Private Health Coverage Benefitting from ACA Provisions Previous analyses by the Office of the Assistant Secretary for Planning and Evaluation (ASPE) estimated that approximately 137 million Americans with private insurance had access to preventive services without cost sharing in 2015. 10, ** Using the same method, ASPE estimates that about 151.6 million had such coverage in 2020. The increase is due in part to growth in the number of people enrolled in private health coverage and a decrease in the share of such people enrolled in grandfathered plans. In 2020, the most recent year of data available, 175.9 million people under age 65 had private health coverage, mainly through an employer, but also including coverage purchased through a state or federal Marketplace. 11 The 2020 Kaiser Family Foundation Employer Health Benefits survey found that 14 percent of individuals with employer-based health plans were enrolled in grandfathered plans, which are not required to provide preventive service coverage with zero cost-sharing (we assume that these individuals are subject to some level of cost sharing for preventive services). Data from the 2020 Final Rule on Grandfathered Health Plans and from the 2020 National Health Expenditures Accounts suggest that at most 12 percent of people with individual market coverage are enrolled in grandfathered health plans. †† Using these statistics, we estimate that a total of approximately 151.6 million individuals 12 currently have private health coverage that covers preventive services with zero cost-sharing (Figure 1). 13 This includes approximately 58 million women, 57 million men, and 37 million children. Table 1 presents state-level estimates. _______________________ ** ASPE released a different estimate in 2012 focused on the number of people newly gaining coverage for free preventive services, based on how many people with private coverage already had access to preventive care vs. how many were gaining it for the fir st time, with an estimate of 54 million. The more recent reports, including this report, provide estimates of how many total people have private coverage without cost-sharing for these services, whether or not some may have had similar coverage prior to the ACA. †† See Figure 1 sources for more information on this estimate. JANUARY 2022 ISSUE BRIEF 3 Figure 1.Estimated Number of Individuals with Private Health Coverage, by Age and Gender, with Preventive Services Coverage without CostSharing, 2020 (in millions) 160 151.6 Number of Americans (in millions) 140 120 100 80 60 40 58.0 56.5 Women 19-64 Men 19-64 37.1 20 0 Children 0-18 Total No t e: ASPE subtracted estimated 14% and 12% of grandfathered plan enrollees from the total number of individuals with employee sponsored health insurance and the total number of individuals with nongroup insurance, respectively, to estimate the number of privately covered individuals with preventive services coverage without cost-sharing. So u rces: Privately insured individuals, by age and gender: 2020 Kaiser Family Foundation State Health Facts on Health Coverage and the Uninsured, developed from the 2017-2021 Current Population Survey (CPS) Annual Social and Economic Supplements: https://www.kff.org/statecategory/health-coverage-uninsured/ Grandfathered plan estimates: 2020 Kaiser Family Foundation Employer Health Benefits Survey: https://www.kff.org/health-costs/report/2020-employer-health-benefits-survey/ Non group estimate calculated from 2020 Final Rule on Grandfathered Health Plans and 2020 National Health Expenditures Table 22 on coverage: https://www.govinfo.gov/content/pkg/FR-2020-12-15/pdf/2020-27498.pdf https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-andReports/NationalHealthExpendData/NationalHealthAccountsHistorical JANUARY 2022 ISSUE BRIEF 4 Table 1. State-level Estimates of Individuals with Private Health Coverage with Preventive Services Coverage without Cost-Sharing, 2020 (in thousands) United States Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming JANUARY 2022 Children (