The Affordable Care Act and the “Magic Bullet”

The Affordable Care Act and the “Magic Bullet”

By Miguel Marino

The ‘magic bullet’ to cure all diseases is to prevent them. Along with disease treatment, preventive medicine is practiced by primary care physicians to help their patients maintain their health. The United States has made tremendous efforts to make preventive medicine more accessible to patients. However, there are still barriers to those services. One possible barrier is the lack of having health insurance. While most middle-class Americans are able secure stable health insurance because of their employment and financial stability, there is a sizable population of low-income, vulnerable patients who may not have the means to maintain steady health insurance. Part of the goals of the Affordable Care Act (ACA) and state programs like the ACA was to aid people in gaining and maintaining health insurance to be able to receive the acute care and preventive service care that are sorely needed in those populations. However, there were few studies that showed whether or not providing health insurance to uninsured would help people get necessary preventive services. As such, we set out to help answer that question.

Our study, published in the American Journal of Preventive Medicine, provides some of the strongest evidence that gaining health insurance directly causes increases in preventive services among patients who seek care in community health centers (clinics that serve low-income, vulnerable populations). Our study leveraged a strong component commonly found in clinical trials (i.e. randomization) to establish the causal relationship between gaining insurance and increase rates of preventive services. Specifically, we studied patients who participated in the ‘Oregon Experiment’ (a randomized natural experiment of Medicaid expansion enrollment), and compared receipt of preventive services over a 36-month (2008-2011) follow-up among those randomly selected to apply for Medicaid versus not assigned. For 8 of the 12 assessed preventive services, Medicaid coverage significantly increased the odds of receipt of preventive services (screenings for body mass index, blood pressure, smoking; test of pap, mammography, FOBT, chlamydia, and HbA1c).

This study suggests that rates of preventive services receipt will likely increase as community health center patients gain insurance through ACA expansions. Continued effort is needed to increase health insurance coverage in an effort to improve patient health and decrease health disparities in vulnerable populations.