Online Program

Preventive services under the affordable care act: Identifying gaps in coverage

Tuesday, November 5, 2013 : 10:45 a.m. - 11:00 a.m.

Katie Keith, J.D., M.P.H., Trimpa Group, Washington, DC
Preventive services are associated with positive population health outcomes but are often underutilized. Because health insurance coverage is a key determinant of the use of such services, the Affordable Care Act greatly expanded access to specified preventive services without cost-sharing. It did not, however, displace state mandates for preventive services. In this paper, I present a comprehensive review and gap analysis of state mandates for the coverage of preventive services by private health insurers. Relevant state laws and regulations are identified using commercial legal databases and state websites with findings confirmed by state insurance regulators. State mandates are then analyzed based on the target population; the frequency, method, and scope of the preventive service; whether the state law is preempted; and cost-sharing requirements. The study is the first-ever comprehensive review of state mandates on preventive services in all 50 states and D.C. Existing reviews are limited in scope or outdated. The analysis also identifies regulatory gaps in the coverage of preventive services that exist even under the new federal standard. The study will inform federal policy on preventive services, allow states to assess whether to update their laws and regulations, and assist advocates in developing a strategy to address gaps at the state or federal level. This research could also enable future study on the effects of state mandates on utilization of preventive services and, ultimately, population health outcomes.

Learning Areas:

Other professions or practice related to public health
Public health or related laws, regulations, standards, or guidelines
Public health or related organizational policy, standards, or other guidelines
Public health or related public policy

Learning Objectives:
Identify how the preventive services requirements in the Affordable Care Act are reflected in state preventive services mandates. Describe the gaps that remain in the coverage of such services if there is no additional federal or state guidance.

Keyword(s): Access and Services, Insurance

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I specialize in private health insurance and, in particular, the new market reforms under the Affordable Care Act. I have been the principal of foundation grants and worked on projects with the Robert Wood Johnson Foundation, the Kaiser Family Foundation, the Commonwealth Fund, and the Urban Institute. I am experienced in conducting comprehensive surveys of state legal requirements, performing preemption analyses, and working collaboratively with state insurance regulators.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.