Ongoing Implementation Challenges to the Patient Protection and Affordable Care Act’s Contraceptive Mandate

Hall, Kelli Stidham; Kottke, Melissa; Dalton, Vanessa K.; Hogue, Carol R.

doi:10.1016/j.amepre.2016.10.014

Cited by 3 publications

(3 citation statements)

References 10 publications

(11 reference statements)

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“…37 For example, although the ACA required that private health insurance plans cover contraceptive counseling and FDA-approved treatments with zero cost-sharing, awareness of these mandates among insured patients remained low. 38 Increased clinician and patient awareness of the opportunities for smoking cessation afforded by the ACA may increase use of any TCP and combination TCP, contribute to successful quit attempts, and reduce tobacco-related health disparities. 39,40 However, it may be unrealistic to expect clinicians to educate patients about benefit details, since providers also may be unclear about benefit provisions.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the Impact of Eliminating Copayments for Tobacco Cessation Pharmacotherapy

et al. 2018

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Objectives: We examined the impact of the Affordable Care Act (ACA) mandated elimination of tobacco cessation pharmacotherapy (TCP) copayments on patient use of TCP, overall and by income. Methods: Electronic health record data captured any and combination (e.g., nicotine gum plus patch) TCP use among adult smokers newly enrolled in Kaiser Permanente Northern California (KPNC). KPNC eliminated TCP copayments in 2015. We included current smokers newly enrolled in the first 6 months of 2014 (before copayment elimination; N=16,199) or 2015 (after elimination; N=16,469). Multivariable models estimated one-year changes in rates of any TCP fill, and of combination TCP fill, and tested for differences by income (<$50K, $50–75K, ≥$75K). Through telephone surveys in 2016 with a subset of smokers newly enrolled in 2014 (n = 306), we assessed barriers to TCP use, with results stratified by income. Results: Smokers enrolled in KPNC in 2015 versus 2014 were more likely to have a TCP fill (9.1% vs. 8.2%; RR=1.19, 95%CI=1.11–1.27), and combination TCP fill, among those with any fill (42.3% vs. 37.9%; RR=1.12, 95%CI=1.02–1.23); findings were stronger for low-income smokers. Low-income patients (<$50K) were less likely to report that clinicians discussed smoking treatments with them (58%) compared to higher income smokers ($50–75K, 67%; ≥$75K, 83%), and were less aware that TCP was free (40% vs. 53% and 69%, respectively, ps<.05). Conclusions: The ACA’s copayment elimination was associated with a modest increase in TCP use and a greater effect among low-income smokers. Uptake may have been enhanced if promoted to patients directly and via providers.

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Section: Discussionmentioning

confidence: 99%

Evaluating the Impact of Eliminating Copayments for Tobacco Cessation Pharmacotherapy

et al. 2018

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“…Barriers to LARC use in the United States include high costs and limited insurance coverage. The passage of the Affordable Care Act (ACA) in 2010 should have resolved these barriers for people with health insurance; however, the application of the contraceptive care component of the ACA has been uneven 7 and individuals may be unaware that methods of LARC are available without charge 8 . In addition, uptake has been slowed by challenges such as scheduling, 9 potential users' discomfort with “newer” contraceptive methods, 10 distrust because of a history of reproductive coercion targeting women of color and women living with physical and intellectual disabilities, 2,11 and some providers' reluctance to remove LARC after insertion 12 .…”

Section: Introductionmentioning

confidence: 99%

Factors associated with never‐use of long‐acting reversible contraception among adult reproductive‐aged women in Ohio

Chakraborty

Chettri

Gallo

et al. 2022

Perspect Sexual Reproductive

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Background The number of women using long‐acting reversible contraception (LARC)—intrauterine devices (IUDs) and implants—is increasing and 14% of contraceptive users in the United States adopt LARC. We examined correlates of LARC never‐use in a population‐based survey of reproductive‐aged women in Ohio. Methods We analyzed data from the 2018‐19 Ohio Survey of Women. We examined the prevalence of LARC never‐use and reasons for never‐use among ever users of contraception (N = 2388). Using Poisson regression to generate prevalence ratios (PRs), we examined associations between selected correlates (demographic factors, healthcare access/quality measures, and religious/political views) and LARC never‐use. Results Most Ohio women (74%) had never used LARC. Commonly reported reasons for not using an IUD or an implant were preferring a different method (46% and 45%, respectively), not wanting an object inside their body (45% and 43%), side effect concerns (39% and 33%), insertion/removal concerns (31% and 25%), and unfamiliarity (13% and 20%). Conservative political views (PR: 1.12, 95% confidence interval [CI]: 1.04–1.22), pro‐life affiliation (PR: 1.11, 95% CI: 1.02–1.20), placing high importance on religion in daily life (PR: 1.15, 95% CI: 1.06–1.26), and being non‐Hispanic white as compared to non‐Hispanic Black (PR: 1.20, 95% CI: 1.02–1.41) were significantly associated with LARC never‐use. Findings were generally similar for models analyzing IUD and implant never‐use separately. Conclusions Among ever‐users of contraception, LARC never‐use was associated with having conservative political views, being religious, and having a pro‐life affiliation. Except for race/ethnicity, demographic and healthcare measures were not associated with LARC never‐use among women in Ohio.

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“…The medical community can help to empower women by providing them with the evidence-based information needed to make informed, patient-centered decisions about family planning to achieve their reproductive goals. Toward this end, the entire health system must be educated and trained in providing best practices, research must continually update risk–benefit assessments, and health policymakers must identify and eliminate gaps in coverage for the full range of contraceptive options (10). As the debate on federally assisted health insurance continues, it is incumbent on all to base health care recommendations, rules, and access on evidence rather than sentiment.…”

mentioning

confidence: 99%

Hormonal Contraceptives Improve Women's Health and Should Continue to Be Covered by Health Insurance Plans

2017

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Ongoing Implementation Challenges to the Patient Protection and Affordable Care Act’s Contraceptive Mandate

Cited by 3 publications

References 10 publications

Evaluating the Impact of Eliminating Copayments for Tobacco Cessation Pharmacotherapy

Evaluating the Impact of Eliminating Copayments for Tobacco Cessation Pharmacotherapy

Factors associated with never‐use of long‐acting reversible contraception among adult reproductive‐aged women in Ohio

Hormonal Contraceptives Improve Women's Health and Should Continue to Be Covered by Health Insurance Plans

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