This study examines the impact of the Affordable Care Act and Medicaid expansion on the reproductive health care provided in community health centers.
Study Overview
Problem: Reproductive health is a central component of preventive care. Despite the evidence of its importance and effectiveness, there are well-documented disparities in access to and utilization of reproductive health care services, especially among racial and ethnic minorities and people with lower incomes. The Affordable Care Act (ACA) sought to increase access to vital reproductive care services through the expansion of Medicaid coverage. However, only 31 States voluntarily expanded Medicaid, and the impact of expansion on reproductive services is not well understood.
Main Objective: 1) To use the natural experiment of Medicaid expansion in some States but not others, to better understand the impact of the ACA on access to comprehensive preventive, contraceptive, and pregnancy-related care; and 2) To examine the essential role community health centers in the US play in connecting women to quality reproductive health care.
Approach: The study uses electronic health record (EHR) data from the ADVANCE clinical data research network (CDRN) and community data. The research team uses patient-level data for over 3 million patients to examine the provision and utilization of reproductive services before and after Medicaid expansion, and between expansion and non-expansion states. The team also uses EHR data to identify the individual, clinic, and state-level factors associated with reproductive health care. In addition, the research team collects qualitative data to understand patient and provider perspectives on access to reproductive care in community health centers.
Results: The research team found that five out of six key preventive care services (screening for HIV, cervical cancer, and chlamydia; and vaccination for HPV and influenza) increased at community health centers in both expansion and non-expansion states after the expansion of Medicaid, but remain low across the board.1 The research team also found that community health centers play an important role in providing the most effective contraceptive methods for women with lower incomes.2 These and additional publications from the grant are posted here.
Primary Care Relevance
Findings from this study show that the policies that fund health centers and expand coverage for reproductive health services in primary care settings are effective ways to ensure ongoing access to equitable reproductive health care.
AHRQ Primary Care Priority Area
Research to improve primary care, including regarding quality, access and affordability, the workforce, care delivery models, financing, digital healthcare, person-centeredness, and health equity.
Notes
1. Hatch, B., Hoopes, M., Darney, B.G., Marino, M., Templeton, A.R., Schmidt, T., Cottrell, E. (2021). Impacts of the affordable care act on receipt of women's preventive services in community health centers in Medicaid expansion and nonexpansion states. Womens Health Issues 31(1):9-16. doi: 10.1016/j.whi.2020.08.011.
2. Darney B.G., Biel F.M., Oakley J., Rodriguez M.I., Cottrell, E.K. (2022). US "safety net" clinics provide access to effective contraception for adolescents and young women, 2017-2019. American Journal of Public Health 112(S5):S555-S562. doi: 10.2105/AJPH.2022.306913.
