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U.S. Department of Health & Human Services aspe.hhs.gov Office of the Assistant Secretary for Planning and Evaluation
ASPE ISSUE BRIEF
Seventy-one million additional Americans are receiving preventive services coverage without cost-sharing under the Affordable Care Act
March 2013
By: Laura Skopec, Benjamin D. Sommers
Abstract
The Affordable Care Act ensures that most insurance plans (so-called ‘non-grandfathered’ plans) provide coverage for and eliminate cost-sharing on certain recommended preventive health services, beginning on or after September 23, 2010. 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. While some plans already covered these services, millions of Americans were previously in health plans that did not. Using information from the Kaiser Family Foundation’s Employer Health Benefits Survey and the most recent data from the Census Bureau, we estimate that approximately 71 million Americans are now receiving expanded coverage of one or more preventive services due to the Affordable Care Act.
This issue brief is available on the Internet at:
http://158.74.49.3/health/reports/2013/PreventiveServices/ib_prevention.cfm
Fifty-Four Million Additional Americans Are Receiving Preventive Services Coverage Without Cost-Sharing Under The Affordable Care Act

 


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

 

Laura Skopec and Benjamin D. Sommers, ASPE

The Affordable Care Act ensures that most insurance plans (so-called ‘non-grandfathered’ plans) provide coverage for and eliminate cost-sharing on certain recommended preventive health services, beginning on or after September 23, 2010.[1]  Based in part 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 services.[2]



While some plans already covered these services, millions of Americans were enrolled in health plans that did not.  According to the Kaiser Family Foundation’s Employer Health Benefits Survey in 2012, 41% of all workers were covered by employer-sponsored group health 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 are enrolled in private health coverage.[4]  Putting these facts together, we estimate that approximately 71 million Americans received expanded coverage of one or more preventive services in 2011 and 2012 due to the Affordable Care Act.[5]



Using national survey data on children and adults with private insurance, we next estimated how those 71 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 ages 50 to 64; recommended immunizations such as HPV vaccination for those 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.  For plan years (in the individual market, policy years) beginning on or after August 1, 2012, additional preventive services specific to women, such as well-woman visits, screening for gestational diabetes, domestic violence screening and counseling, and prescription, FDA-approved contraception, must be covered with no cost sharing.[6]

 

·         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.[7]


 

FIGURE 1: Number of Americans Estimated to be Receiving Expanded Preventive Services Coverage

Under the Affordable Care Act (in Millions)[8]

 

 

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

 


 

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

        1,084,000

          272,000

          426,000

          386,000

Alaska

          164,000

            44,000

            60,000

            60,000

Arizona

        1,406,000

          377,000

          518,000

          511,000

Arkansas

          578,000

          144,000

          224,000

          209,000

California

        8,061,000

        2,118,000

        2,987,000

        2,956,000

Colorado

        1,288,000

          348,000

          478,000

          462,000

Connecticut

          945,000

          246,000

          361,000

          338,000

Delaware

          218,000

            57,000

            84,000

            78,000

District of Columbia

          141,000

            22,000

            63,000

56,000

Florida

        3,762,000

          912,000

        1,470,000

        1,380,000

Georgia

        2,202,000

          592,000

          843,000

          767,000

Hawaii

          323,000

            79,000

          122,000

          122,000

Idaho

          367,000

          109,000

          130,000

          128,000

Illinois

        3,047,000

          762,000

        1,153,000

        1,131,000

Indiana

        1,508,000

          406,000

          554,000

          548,000

Iowa

          801,000

          206,000

          298,000

          297,000

Kansas

          684,000

          186,000

          255,000

          242,000

Kentucky

          975,000

          243,000

          374,000

          359,000

Louisiana

          932,000

          238,000

          356,000

          338,000

Maine

          301,000

            70,000

          122,000

          109,000

Maryland

        1,518,000

          382,000

          590,000

          546,000

Massachusetts

        1,773,000

          433,000

          690,000

          650,000

Michigan

        2,386,000

          637,000

          901,000

          848,000

Minnesota

        1,412,000

          380,000

          520,000

          511,000

Mississippi

          586,000

          152,000

          226,000

          208,000

Missouri

        1,441,000

          379,000

          532,000

          529,000

Montana

          213,000

            52,000

            82,000

            78,000

Nebraska

          477,000

          128,000

          176,000

          173,000

Nevada

          615,000

          171,000

          223,000

          220,000

New Hampshire

          365,000

            91,000

          141,000

          133,000

New Jersey

        2,209,000

          590,000

          816,000

          802,000

New Mexico

          373,000

            95,000

          146,000

          132,000

New York

        4,401,000

        1,077,000

        1,743,000

        1,581,000

North Carolina

        2,062,000

          519,000

          797,000

          746,000

North Dakota

          180,000

            46,000

            67,000

            67,000

Ohio

        2,742,000

          695,000

        1,037,000

        1,010,000

Oklahoma

          811,000

          210,000

          309,000

          292,000

Oregon

          907,000

          220,000

          360,000

          327,000

Pennsylvania

        3,151,000

          761,000

        1,218,000

        1,172,000

Rhode Island

          252,000

            60,000

            99,000

            93,000

South Carolina

          980,000

          256,000

          388,000

          336,000

South Dakota

          200,000

            53,000

            74,000

            73,000

Tennessee

        1,413,000

          356,000

          542,000

          515,000

Texas

        5,198,000

        1,407,000

        1,923,000

        1,868,000

Utah

          787,000

          267,000

          261,000

          259,000

Vermont

          151,000

            31,000

            62,000

            58,000

Virginia

        1,998,000

          535,000

          765,000

          698,000

Washington

        1,620,000

          376,000

          638,000

          606,000

West Virginia

          398,000

            96,000

          153,000

          148,000

Wisconsin

        1,459,000

          378,000

          542,000

          538,000

Wyoming

          136,000

            36,000

            48,000

            51,000

TOTAL

      71,001,000

      18,300,000

      26,947,000

      25,745,000

 



[1] Interim Final Rules for Group Health Plans and Health Insurance Issuers Relating to Coverage of Preventive Services Under the Patient Protection and Affordable Care Act, U.S. Departments of Treasury; Labor; and Health and Human Services. 75 C.F.R. 41726 (Jul. 19, 2010).

[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: 2012 Summary of Findings.  Exhibit 13.7 shows that 41% of workers were in plans “where the services considered preventive changed because of the ACA.”  The same analysis shows that 27% of workers 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 41% 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 of workers affected by expanded coverage or by reduced cost sharing as a result of the ACA could have been even higher than 41% and as high as 68% (41% + 27%).

[4] DeNavas-Walt C, Proctor BD, Smith JC. Census Bureau, Current Population Reports, P60-243, Income, Poverty, and Health Insurance Coverage in the United States: 2011, Government Printing Office, Washington, DC, 2012.

[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 41% of people in the non-group market likely experienced expanded coverage for preventive services due to this provision.

[6] Certain religious employers are exempt from this requirement with respect to certain contraceptive services that otherwise would be required to be covered without cost sharing.  In addition, with respect to certain other non-profit organizations with religious objections to contraception coverage, the Department of Health and Human Services (and the Departments of Labor and the Treasury) have provided for a temporary enforcement safe harbor during which rulemaking is being undertaken to accommodate such objections while preserving these latter organizations’ employees’ right to contraception coverage without cost sharing.

[7] Data come from the Census Bureau’s Current Population Survey, for the years 2010-2012.  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 71 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.

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