December 2015Vol. 16, No. 9Barriers to Accessing Preventive Services in the ACA

Young people between the ages of 15 and 24 are more likely to experience unplanned pregnancy and sexually transmitted infections (STIs) than individuals in most other age groups; therefore, increasing access to preventive health-care services can make a significant difference in their lives. The Affordable Care Act (ACA) has made it possible for many young people to access a broad range of sexual and reproductive health-care services. The ACA requires most health plans to cover preventive services without cost sharing (when the patient pays for a portion of his or her own health-care costs not covered by health insurance), such as screenings for STIs and HIV, contraceptive and pregnancy-related care, and HPV immunizations. While the ACA has improved access to critical health-care services, there remain a number of obstacles to the successful implementation of the preventive services provisions of the ACA.

A November 2014 paper by Advocates for Youth, an organization dedicated to promoting effective adolescent reproductive and sexual health programs and policies in the United States and internationally, analyzes the preventive services afforded to young people through the ACA and provides recommendations for policymakers, providers, and advocates on what they can do to help ensure young people have access to the health care they need. Advocates for Youth staff conducted interviews with a variety of State-level experts in Georgia, North Carolina, South Carolina, and Massachusetts to assess the effect of ACA implementation on young people's access to confidential sexual and reproductive health-care services.

The paper provides ACA background; an overview of the preventive services available without cost-sharing, exempt plans/exceptions to the no cost-sharing requirement, and scenarios when individuals could still pay out of pocket for preventive services; a review of preventive services and Medicaid; and it outlines which Federal and State agencies are responsible for enforcing the ACA preventive services provisions and implementation.

Perhaps most notable to professionals in the youth services field are the sections that discuss the barriers to access to preventive health services for young people and the issue of awareness, or lack thereof, of benefits under the ACA. Even with appropriate health coverage, many young people still encounter obstacles to accessing no cost-sharing preventive services. This paper examines the three main barriers: lack of awareness of eligible benefits, lack of confidentiality and consent, and discomfort and stigma. In an effort to address these challenges, the authors present a number of recommendations for policymakers, service providers, and advocates/program planners. The paper also includes an appendix of ACA regulations affecting youth.

Ensuring Young People's Access to Preventive Services in the Affordable Care Act was written by Kashif Syed, Reproductive Justice Fellow, with Assistance from Hilary O'Brien, Associate, Teen Pregnancy Prevention, and based on research by Amber Morley Rieke, M.P.H., George Washington University. It is available on the Advocates for Youth website at http://www.advocatesforyouth.org/publications/publications-a-z/2461-ensuring-young-peoples-access-to-preventive-services-in-the-affordable-care-act-.