Preventive Health Services Under the Affordable Care Act: Role of Delivery System Reform

Anthony Shih, MD, MPH; Julia A. Berenson, MSc; Melinda Abrams, MS


April 12, 2012

In This Article


The enactment of the Patient Protection and Affordable Care Act (commonly referred to as the "Affordable Care Act" or "healthcare reform") was a historic event that, if fully implemented, will have a profound impact on healthcare in the United States.[1] Most notably, the Affordable Care Act will significantly reduce the number of uninsured patients, reform the insurance markets, and spur improvements to the healthcare delivery system.[2]

Among healthcare professionals interested in the field of prevention, it is natural to focus on the Prevention and Public Health Fund established under healthcare reform. The Fund is anticipated to provide $15 billion over 10 years to strengthen the capacity of prevention and public health efforts in the United States. In 2010 and 2011, the US Department of Health and Human Services distributed $500 million and $750 million of the Fund to state and local communities, respectively, throughout the United States.[3] Yet, policymakers recently have targeted the Fund for legislative cuts owing to large federal budget deficits and pressures to pay for other initiatives.[4]

Despite the value and importance of the Fund, it is likely that other provisions of the Affordable Care Act -- specifically, the role of healthcare reform in increasing access to insurance coverage, reducing financial barriers to care, and delivery system reform -- will have a greater impact on the use of preventive services in the United States.

Expansion of Insurance and Reducing the Financial Barriers to Preventive Services

The Affordable Care Act includes numerous provisions that will dramatically expand health insurance coverage. These include:

  • Extension of health coverage for dependent children up to age 26 years;

  • Expansion of Medicaid eligibility to include most nonelderly low-income adults;

  • Creation of health insurance exchanges with affordable and subsidized insurance coverage options for individuals and small businesses; and

  • The "individual mandate" that requires nearly all legal US residents to obtain health insurance.[5]

Young adults. Since September 2010, healthcare reform has required health plans that offer dependent coverage to allow children under the age of 26 years to remain on or join their parents' policies. This provision is already making a difference for young adults, who are among the groups most at risk for lacking health insurance in the United States. A recent report by the US Department of Health and Human Services found that in the first year of implementation, 2.5 million young adults (age 19-25 years) gained health insurance coverage between September 2010 and June 2011.[6] However, the law's most far-reaching changes are yet to come: Most people who are still uninsured will gain health insurance coverage through other provisions of the Affordable Care Act that will go into effect in 2014.

Low income. In 2014, the Affordable Care Act will extend Medicaid eligibility to nearly all residents younger than 65 years with incomes below 133% of the federal poverty level. As a result, Medicaid is expected to cover an additional 17 million low-income people by 2021.[7]

Insurance exchanges. Healthcare reform requires each state to establish a health insurance exchange by 2014, in which individuals and small businesses can purchase affordable and subsidized health insurance plans. It is estimated that an additional 24 million people will purchase their own coverage through exchanges by 2021.[7] In 2014, the Affordable Care Act will also make tax credits available to low- and modest-income people to offset the cost of health insurance premiums.

The individual mandate. An important part of the Affordable Care Act is the requirement (or "individual mandate") that everyone have health insurance coverage. Beginning in 2014, all US citizens and legal residents will be required to maintain minimum coverage or face a penalty.


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