Impact of the Affordable Care Act on preventive service use

The implementation of the Affordable Care Act (ACA) in 2010 made a significant impact on improving accessibility of healthcare in the U.S. The ACA requires that most individuals have health insurance. It also mandates that health insurance plans cover a minimum level of preventive services and eliminate cost-sharing to its members for these services. These mandates help to serve the overall goal of the ACA, which is to improve health. With its goals of improving health through preventive care and reducing access-related barriers, the ACA is arguably the most important piece of public health legislation in decades. The ACA contributes to public health efforts by assuring that low-income populations gain insurance coverage through Medicaid expansion and subsidies to purchase coverage through the marketplace. Lastly, the ACA contains several provisions that aim to improve quality of care, which is determined through monitoring and assessing specific disease measures of patients. While the ACA is clear that it seeks to improve the use of preventive services, little evidence exists on its impact on preventive care uptake. This paper evaluated preventive care use for heart disease and breast cancer, as both are leading causes of death in the U.S. Several healthcare industries affected by the ACA, specifically health plans, hospitals, and providers, were explored by discussing expectations that the ACA places on these industries to improve quality of care. Additionally, industry examples were provided to demonstrate individual efforts to improve quality. Costs were also briefly discussed since the Act suggests that improving preventive service uptake will help reduce healthcare expenditures. A definitive conclusion on the ACA’s effectiveness for improving mammography and heart disease prevention uptake could not be determined so soon after its implementation. More time is needed to implement quality initiatives and collect data on preventive service use. Additionally, it was found that increasing preventive service use may not yield cost savings, which is consistent with the literature on heterogeneity in the cost-effectiveness of preventive services. Instead, it may be better to measure these services based on overall value of care through quality adjusted life years.