Fifty-Four Million Additional Americans Are Receiving Preventive Services Without Cost-Sharing Under The Affordable Care Act

02/15/2012

ASPE ISSUE BRIEF

Fifty-Four Million Additional Americans Are Receiving Preventive Services Coverage Without Cost-Sharing Under The Affordable Care Act

February 2012

By: Benjamin D. Sommers and Lee Wilson ASPE

This Issue Brief is available on the Internet at:http://aspe.hhs.gov/health/reports/2012/PreventiveServices/ib.shtml

Printer Friendly (PDF) Version (4 pages) [Free PDF reader exit disclaimer]

The Affordable Care Act requires many insurance plans (so-called non-grandfathered plans) to provide coverage for and eliminate cost-sharing on certain recommended preventive health services, for policies renewing on or after September 23, 2010.[1]  Based primarily on guidelines from the U.S. Preventive Services Task Force, this includes services such as colonoscopy screening for colon cancer, Pap smears and mammograms for women, well-child visits, flu shots for all children and adults, and many more.[2]

While some plans already covered these services, millions of Americans were previously in health plans that did not. According to the Kaiser Family Foundations Employer Health Benefits Survey in 2011, 31% of all workers were covered by plans that expanded their list of covered preventive services due to the Affordable Care Act.[3]  The most recent data from the Census Bureau show that 173 million Americans ages 0 to 64 currently have private coverage.[4]  Putting these facts together, we estimate that approximately 54 million Americans received expanded coverage of at least some preventive services due to the Affordable Care Act in 2011.[5]

Using national survey data on children and adults with private insurance, we next estimated how those 54 million people are distributed across states, and across age, race, and ethnic groups.  We examined the following age/gender groups, and provide here a sample of the services they are now eligible for without any cost-sharing. Note that this is not an exhaustive list of covered services and is only meant to highlight several examples.

  • Children (0-17):  Coverage includes regular pediatrician visits, vision and hearing screening, developmental assessments, immunizations, and screening and counseling to address obesity and help children maintain a healthy weight.
  • Women (18-64):  Coverage includes cancer screening such as pap smears for those ages 21 to 64, mammograms for those ages 50 to 64, and colonoscopy for those 50 to 64; recommended immunizations such as HPV vaccination for women ages 19 to 26, flu shots for all adults, and meningococcal and pneumococcal vaccinations for high-risk adults; healthy diet counseling and obesity screening; cholesterol and blood pressure screening; screening for sexually-transmitted infections and HIV; depression screening; and tobacco-use counseling. Starting in August 2012, additional preventive services specific to women, such as screening for gestational diabetes and contraception, will be covered by new health plans with no cost sharing.
  • Men (18-64):  Coverage includes recommended immunizations such as flu shots for all adults and meningococcal and pneumococcal vaccinations for high-risk adults; cancer screening including colonoscopy for adults 50 to 64; healthy diet counseling and obesity screening; cholesterol and blood pressure screening; screening for HIV; depression screening; and tobacco-use counseling.

Figure 1 presents national totals, including breakdowns by age, gender, race, and ethnicity.  Table 1 presents totals by state.[6]

FIGURE 1: Number of Americans Estimated to be Receiving Expanded Preventive Services Coverage Under the Affordable Care Act (in Millions)[7]

Figure 1: Number of Americans Estimated to be Receiving Expanded Preventive Services Coverage Under the Affordable Care Act (in Millions). Total is 54; Children (0-17) is 14.1, Women (18-64) is 20.4, and Men (18-64) is 19.5; White is 44.3, Latino is 6.1, Black is 5.5, Asian is 2.7, and Native American is 0.3.

TABLE 1: Number of Americans Estimated to be Receiving Expanded Preventive Services Coverage Under the Affordable Care Act, by State
State Total Children Women Men
Alabama 819,000 205,000 319,000 294,000
Alaska 121,000 33,000 44,000 44,000
Arizona 1,056,000 282,000 389,000 385,000
Arkansas 439,000 110,000 170,000 159,000
California 6,181,000 1,638,000 2,286,000 2,257,000
Colorado 973,000 259,000 362,000 352,000
Connecticut 710,000 188,000 270,000 252,000
Delaware 163,000 43,000 61,000 58,000
District of Columbia 107,000 17,000 47,000 42,000
Florida 2,841,000 710,000 1,104,000 1,027,000
Georgia 1,713,000 465,000 654,000 593,000
Hawaii 240,000 59,000 90,000 91,000
Idaho 283,000 86,000 100,000 97,000
Illinois 2,390,000 605,000 898,000 887,000
Indiana 1,160,000 314,000 421,000 425,000
Iowa 611,000 158,000 225,000 228,000
Kansas 529,000 141,000 198,000 191,000
Kentucky 732,000 184,000 274,000 273,000
Louisiana 719,000 193,000 275,000 251,000
Maine 226,000 53,000 91,000 82,000
Maryland 1,153,000 297,000 448,000 408,000
Massachusetts 1,324,000 327,000 517,000 480,000
Michigan 1,849,000 498,000 692,000 658,000
Minnesota 1,056,000 281,000 392,000 383,000
Mississippi 430,000 111,000 167,000 152,000
Missouri 1,102,000 292,000 408,000 401,000
Montana 166,000 41,000 62,000 63,000
Nebraska 359,000 96,000 134,000 129,000
Nevada 477,000 133,000 171,000 173,000
New Hampshire 279,000 70,000 107,000 102,000
New Jersey 1,694,000 449,000 628,000 617,000
New Mexico 285,000 75,000 111,000 100,000
New York 3,342,000 824,000 1,322,000 1,196,000
North Carolina 1,564,000 403,000 600,000 561,000
North Dakota 130,000 33,000 49,000 48,000
Ohio 2,138,000 559,000 797,000 782,000
Oklahoma 616,000 160,000 236,000 220,000
Oregon 692,000 171,000 273,000 248,000
Pennsylvania 2,363,000 580,000 915,000 869,000
Rhode Island 195,000 46,000 76,000 72,000
South Carolina 755,000 201,000 296,000 258,000
South Dakota 151,000 41,000 56,000 54,000
Tennessee 1,044,000 263,000 401,000 380,000
Texas 3,836,000 1,049,000 1,421,000 1,366,000
Utah 605,000 207,000 199,000 198,000
Vermont 115,000 24,000 47,000 44,000
Virginia 1,519,000 410,000 576,000 533,000
Washington 1,239,000 293,000 483,000 463,000
West Virginia 300,000 75,000 113,000 112,000
Wisconsin 1,111,000 295,000 413,000 403,000
Wyoming 102,000 28,000 36,000 38,000
TOTAL 54,004,000 14,075,000 20,424,000 19,499,000

Endnotes

[1]  Preventive Regulations. U.S. Departments of Treasury; Labor; and Health and Human Services.

[2]  Recommended Preventive Services. U.S. Department of Health and Human Services, 2011.  Accessed at:  (http://www.healthcare.gov/law/resources/regulations/prevention/recommendations.html)

[3]  Kaiser Family Foundation  Health Research and Education Trust.  Employer Health Benefits:  2011 Summary of Findings.  Exhibit 13.6 shows that 31% of workers were in plans where the services considered preventive changed because of the ACA.  The same analysis shows that 23% of works were in plans where cost sharing changed for preventive services because of the ACA.  We made the conservative assumption that these two groups overlapped completely, meaning that 31% experienced expanded coverage and/or reduced cost-sharing, though in fact if some people in the second group were not in the first, the overall percentage affected could have been even higher than 31% and as high as 54% (31% + 23%).

[4]  DeNavas-Walt C, Proctor BD, Smith JC. Census Bureau, Current Population Reports, P60-239, Income, Poverty, and Health Insurance Coverage in the United States: 2010, Government Printing Office, Washington, DC, 2011.  [PDF format]

[5]  We included people with non-group plans in this calculation, since non-group coverage tends to be less generous than employer-provided insurance, suggesting that at least 31% of people in the non-group market likely experienced expanded coverage for preventive services due to this provision.

[6]  Data come from the Census Bureaus Current Population Survey, for the years 2009-2011. We use three pooled years to allow for state-level estimates. We analyzed the proportion of all non-elderly individuals (0-64 years old) with private insurance in each category and state listed in Figure 1 and Table 1, and scaled the survey-weighted percentages to total 54 million individuals in aggregate, to match the projected number of people affected by this policy.  Note that this overall approach is only a rough approximation and does not reflect any potential uneven distribution of individuals by age, race/ethnicity, or state of residence in private plans affected by the preventive coverage provisions of the Affordable Care Act.

[7]  The Census Bureau records race and ethnicity separately, which means that totals combining racial and ethnic groups sum to more than 100%.

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