Interrelation of Preventive Care Benefits and Shared Costs under the Affordable Care Act (ACA)

Document Type : Policy Brief


School of Medicine and Health Sciences, The George Washington University, Washington, USA


With the implementation of the Affordable Care Act (ACA), access to insurance and coverage of preventive care services has been expanded. By removing the barrier of shared costs for preventive care, it is expected that an increase in utilization of preventive care services will reduce the cost of chronic diseases. Early detection and treatment is anticipated to be less costly than treatment at full onset of chronic conditions. One concern of early detection of disease is the cost to treat. In reality, the confluence of early detection may result in greater overall expenditures. Even with improved access to preventive care benefits, cost-sharing of other health services remains a major component of insurance plans. In order to treat identified conditions or diseases, cost-sharing comes into play. With the greater adoption of cost-sharing insurance plans, expenditures on the part of enrollee are anticipated to rise. Once the healthcare recipients realize the implication of early identification and resultant treatment costs, enrollment in preventive care may decline. Healthcare legislation and regulation should consider the full spectrum of care and the microeconomic costs associated with preventive treatment. Although the system at large may not realize the immediate impact, behavioral shifts on the part of healthcare consumers may alter healthcare. Rather than the current status quo of treating presenting conditions, preventive treatment is largely anticipated to require more resources and may impact the consumer’s financial capacity. This report will explore how these two concepts are co-dependent, and highlight the need for continued reform.


Main Subjects


    1. Foundation TKF. Summary of the Patient Protection and Affordability Act [internet].  2013 [updated 2014 June]. Available from:
    2. Preventive Care Benefits [internet].  [updated 2014 June]. Available from:
    3. Affordable Care Act Rules on Expanding Access to Preventive Services for Women [internet].  2011 [updated 2014 June]. Available from:
    4. Molinari C. Does the accountable care act aim to promote quality, health, and control costs or has it missed the mark? Comment on “health system reform in the United States”. Int J Health Policy Manag 2014; 2: 97-9.  doi: 10.15171/ijhpm.2014.23
    5. Cassidy A. Health Policy Brief:  Preventive services without cost sharing. Health Aff (Millwood) 2010.  Available from:
    6. Cogan JA. The Affordable Care Act’s Preventive Services Mandate: Breaking Down the Barriers to Nationwide Access to Preventive Services. J Law Med Ethics 2011; 39: 355-65.  doi: 10.1111/j.1748-720X.2011.00605.x
    7. Force USPST. USPSTF A and B Recommendations [internet].   [cited 2014 August]. Available from:
    8. Saloner BP, Sabik LP, Sommers BD. Pinching the Poor? Medicaid Cost Sharing under the ACA. N Engl J Med 2014; 370: 1177-80. doi: 10.1056/NEJMp1316370
    9. Himmelstein DU, Thorne D, Warren E, Woolhandler S. Medical bankruptcy in the United States, 2007: results of a national study. Am J Med 2009; 122: 741-6.  doi: 10.1016/j.amjmed.2009.04.012
    10. Himmelstein DU, Thorne D, Woolhandler S. Medical bankruptcy in Massachusetts: has health reform made a difference? Am J Med 2011; 124: 224-8.  doi: 10.1016/j.amjmed.2010.11.009
    11. Bucks BK, Kennickell AB, Mach TL, More KB. Changes in U.S. family finances from 2004-2007: evidence from the Survey of Consumer Finances. Federal Reserve Bulletin 2009; 92:  A1-56.
    12. Sugden R. Sick and (still) broke: Why the Affordable Care Act won’t end medical bankruptcy. Washington University Journal of Law and Policy 2012; 38: 34. 
    13. Maciosek MV, Coffield AB, Flottemesch TJ, Edwards NM, Solberg LI. Greater Use Of Preventive Services In U.S. Health Care Could Save Lives At Little Or No Cost. Health Aff (Millwood) 2010; 29: 1656-60.  doi: 10.1377/hlthaff.2008.0701
    14. Russell LB. Prevention’s potential for slowing the growth of medical spending [internet]. Washington DC, 2007. Available from:
    15. Cavico FJ, Mujtaba BG. Health and Wellness Policy Ethics. Int J Health Policy Manag 2013; 1: 111-3. doi: 10.15171/ijhpm.2013.19 
    16. Thomson S, Schang L, Chernew ME. Value-Based Cost Sharing In The United States And Elsewhere Can Increase Patients\' Use Of High-Value Goods And Services. Health Aff (Millwood) 2013; 32: 704-12.  doi: 10.1377/hlthaff.2012.0964
    17. McDonough JE. Health system reform in the United States. Int J Health Policy Manag 2014; 2: 5-8.  doi: 10.15171/ijhpm.2014.02
    18. Shah ND, Naessens JM, Wood DL, Stroebel RJ, Litchy W, Wagie A, et al. Mayo Clinic Employees Responded To New Requirements For Cost Sharing By Reducing Possibly Unneeded Health Services Use. Health Aff (Millwood) 2011; 30: 2134-41. doi: 10.1377/hlthaff.2010.0348
    19. Reed ME, Graetz I, Fung V, Newhouse JP, Hsu J. In Consumer-Directed Health Plans, A Majority Of Patients Were Unaware Of Free Or Low-Cost Preventive Care. Health Aff (Millwood) 2012; 31: 2641-8.  doi: 10.1377/hlthaff.2012.0059
    20. Johnson PA, Fitzgerald T. The Affordable Care Act and the opportunity to improve prevention in women: how to make the most of the law. Clin Chem 2014; 60: 138-40.  doi: 10.1373/clinchem.2013.203703