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

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review of state mandates on preventive services in all 50 states and D.C. Existing reviews are limited in scope or outdated.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.