The Impact of The Affordable Care Act on Clinically Recommended Preventive Care Services Among Medicare Beneficiaries 65 Years and Older

Authors

Michelle E. Fields, Florida International UniversityFollow

Document Type

Dissertation

Degree

Doctor of Philosophy (PhD)

Major/Program

Chemistry

First Advisor's Name

Alejandro Arrieta

First Advisor's Committee Title

Co-committee Chair

Second Advisor's Name

Ellen Brown

Second Advisor's Committee Title

Co-Commitee Chair

Third Advisor's Name

Jessica Adler

Third Advisor's Committee Title

Committee Member

Fourth Advisor's Name

Vukosava Pekovic

Fourth Advisor's Committee Title

Committee Member

Keywords

ACA, Preventive care, Medicare

Date of Defense

10-11-2022

Abstract

Despite attempts at health reforms to increase the utilization of preventive care services among adults 65 and older, chronic conditions continued to prevail. Current health reforms eliminating cost-sharing aligned with clinically recommended preventive care services could effectively control avoidable chronic diseases and reduce mortality. This study aimed to assess the impact of the Affordable Care Act (ACA)'s removal of cost barriers and mandated coverage of grade A and B USPSTF (United States Preventive Services Task Force) preventive care services among adults 65 years and older on utilization of services. The study also explores whether the ACA provisions have reduced gaps in healthcare disparities associated with race/ethnicity and income. Data came from the Medical Expenditure Panel Survey (MEPS), a nationally representative survey that includes healthcare expenditures, utilization, payment sources, and insurance coverage among noninstitutionalized populations. The research sample was limited to adults 65 years and older enrolled in Medicare's plan Part B. Respondent information for ten preventive care services was identified from 2006-2016 to assess differences before and after Medicare adopted the ACA's provisions on January 1, 2011. Post-ACA, the utilization rates among older adults increased for nine out of ten preventive services. We also found the alignment of Medicare coverage policy was consistent with seven out of eleven USPSTF clinically recommended grade A and B guidelines, but not for certain cancer screenings (breast, cervical, prostate, and colon). However, relevant inequities in healthcare utilization by race and income continue to exist among older Black men for colon and prostate screenings. Although the ACA has made significant improvements in accessing needed preventive services previously impeded by cost-sharing requirements, other factors contribute to the suboptimal utilization of recommended preventive services for adults 65 years and older.

Identifier

FIDC010867

ORCID

https://orcid.org/0000-0003-1530-0471

Recommended Citation

Fields, Michelle E., "The Impact of The Affordable Care Act on Clinically Recommended Preventive Care Services Among Medicare Beneficiaries 65 Years and Older" (2022). FIU Electronic Theses and Dissertations. 5211.
https://digitalcommons.fiu.edu/etd/5211