Elsevier

Women's Health Issues

Volume 31, Issue 1, January–February 2021, Pages 9-16
Women's Health Issues

Editor's Choice
Impacts of the Affordable Care Act on Receipt of Women's Preventive Services in Community Health Centers in Medicaid Expansion and Nonexpansion States

https://doi.org/10.1016/j.whi.2020.08.011Get rights and content
Under a Creative Commons license
open access

Abstract

Background

The Affordable Care Act (ACA) increased health insurance coverage throughout the United States and improved care delivery for some services. We assess whether ACA implementation and Medicaid expansion were followed by greater receipt of recommended preventive services among women and girls in a large network of community health centers.

Methods

Using electronic health record data from 354 community health centers in 14 states (10 expansion, 4 nonexpansion), we used generalized estimating equations and difference-in-difference methods to compare receipt of six recommended preventive services (cervical cancer screening, human papilloma virus vaccination, chlamydia screening, influenza vaccination, human immunodeficiency virus screening, and blood pressure screening) among active female patients ages 11 to 65 (N = 711,121) before and after ACA implementation and between states that expanded versus did not expand Medicaid.

Results

Except for blood pressure screening, receipt of all examined preventive services increased after ACA implementation in both Medicaid expansion and nonexpansion states. Influenza vaccination and blood pressure screening increased more in expansion states (adjusted absolute prevalence difference-in-difference, 1.55; 95% confidence interval, 0.51–2.60; and 1.98; 95% confidence interval, 0.91–3.05, respectively). Chlamydia screening increased more in nonexpansion states (adjusted absolute prevalence difference-in-difference: −4.21; 95% confidence interval, −6.98 to −1.45). Increases in cervical cancer screening, human immunodeficiency virus screening, and human papilloma virus vaccination did not differ significantly between expansion and nonexpansion states.

Conclusions

Among female patients at community health centers, receipt of recommended preventive care improved after ACA implementation in both Medicaid expansion and nonexpansion states, although the overall rates remained low. Continued support is needed to overcome barriers to preventive care in this population.

Cited by (0)

Brigit Hatch, MD, MPH, is a family doctor and health systems researcher. She is trained in preventive medicine and has special practice and research interests in reproductive health, obstetrics, children's health, treatment of addiction, and public health.

Megan Hoopes, MPH, is a biostatistician with experience in working on grant funded, community-based research teams. Her career has focused on health policy, public health, health disparities, and surveillance in a range of topics including cancer, vital statistics, and women's health.

Blair G. Darney, PhD, MPH, is a reproductive health services researcher and Assistant Professor, OHSU Department of OB/GYN and OHSU-PSU School of Public Health. Her work focuses largely on secondary analysis of existing data to study obstetric outcomes, maternal mortality, and contraception.

Miguel Marino, PhD, is a biostatistician with OHSU Department of Family Medicine and OHSU-PSU School of Public Health. He focuses on novel statistical methodologies to use electronic health records in pragmatic randomized trials and observational studies of policy changes and health disparities.

Anna Rose Templeton, DNP, is an OCHIN Research Associate trained in community health. She directs the EVERYWOMAN project and leads OCHIN and ADVANCE's patient, provider, and health system engagement. Her focus is on pragmatic research and resources to improve practice and policy.

Teresa Schmidt, PhD, MPH, is trained in systems science and studies health informatics and health policy including network inference and data mining methods to inform public health policy. She leads work using electronic health record data across multiple OCHIN and ADVANCE studies.

Erika Cottrell, PhD, MPP, is the Principal Investigator on this project. She is jointly appointed as an investigator at OCHIN and Assistant Professor at OHSU. Her primary areas of research include social determinants of health, health equity, maternal/child health, and health policy.

Funding Statement: EVERYWOMAN is funded by the Agency for Healthcare Research and Quality award 1R01HS025155-01. EVERYWOMAN is conducted with the Accelerating Data Value Across a National Community Health Center Network (ADVANCE) Clinical Research Network (CRN). The ADVANCE network is led by OCHIN in partnership with Health Choice Network, Fenway Health, Oregon Health and Science University, and the Robert Graham Center HealthLandscape. ADVANCE is funded through the Patient Centered Outcomes Research Institute (PCORI), contract number RI-CRN-2020-001.