title: The ACA's Zero Cost-Sharing Mandate and Trends in Out-of-Pocket Expenditures on Well-Child and Screening Mammography Visits.
abstract: BACKGROUND
  Starting in September of 2010, the Patient Protection and Affordable Care Act required most health insurance policies to cover evidence-based preventive care with no cost-sharing (no copays, coinsurance, or deductibles). It is unknown, however, whether declines in out-of-pocket costs for preventive services are large enough to prompt increases in utilization, the ultimate goal of the policy.
  
  
  METHODS
  In this study, we use a nationally representative sample of ambulatory care visits to estimate the impact of the zero cost-sharing mandate on out-of-pocket expenditures on well-child and screening mammography visits. Estimates are made using 2-part interrupted time-series models, with well-woman visits serving as the control group because they were not covered under the zero cost-sharing mandate until after our study period.
  
  
  RESULTS
  Results indicate a substantial reduction in out-of-pocket costs attributable to the Affordable Care Act. Between January 2011 and September 2012, the zero cost-sharing mandate reduced per-visit out-of-pocket costs for well-child visits from $18.46 to $8.08 (56%) and out-of-pocket costs for screening mammography visits from $25.43 to $6.50 (74%). No reduction was apparent for well-woman visits.
  
  
  CONCLUSIONS
  The Affordable Care Act's zero cost-sharing mandate for preventive care has had a large impact on out-of-pocket expenditures for well-child and mammography visits. To increase preventive service use, research is needed to better understand barriers to obtaining preventive care that are not directly related to cost.
authors.affiliation: *Agency for Healthcare Research and Quality, Rockville, MD †Yale School of Public Health, New Haven, CT.
authors.forename: James B
authors.initials: JB
authors.lastname: Kirby
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Davidoff
authors.forename: Jayasree
authors.initials: J
authors.lastname: Basu
mesh_terms: D002648:Child; D017047:Cost Sharing / Q000191:economics / Q000331:legislation & jurisprudence*; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D008327:Mammography / Q000191:economics*; D037141:Mandatory Programs / Q000191:economics; D058991:Patient Protection and Affordable Care Act / Q000191:economics / Q000331:legislation & jurisprudence* / Q000458:organization & administration; D011315:Preventive Medicine / Q000191:economics* / Q000331:legislation & jurisprudence; D014481:United States