Receipt of Selected Clinical Preventive Services by Adults ­ United States, 2011-2012.

Preventive services are available for nine of the ten leading causes of death in the United States. The Affordable Care Act (ACA) has reduced cost as a barrier to care by expanding access to insurance and requiring many health plans to cover certain recommended preventive services without copayments or deductibles. To establish a baseline for the receipt of these services for monitoring the effects of the law after 2012, CDC analyzed responses from persons aged ≥18 years in the National Health Interview Survey (NHIS) for the years 2011 and 2012 combined. NHIS is an in-person interview administered annually to a nationally representative sample of the noninstitutionalized, U.S. civilian population. This report summarizes the findings for nine preventive services covered by the ACA. Having health insurance or a higher income was associated with higher rates of receiving these services, affirming findings of previous studies. Securing health insurance coverage might be an important way to increase receipt of clinical preventive services, but insurance coverage is not sufficient to ensure that everyone is offered or uses clinical services proven to prevent disease. Greater awareness of ACA provisions among the public, public health professionals, partners, and health care providers might help increase the receipt of recommended services.

Clinical Preventive Services Coverage and the Affordable Care Act.

The Affordable Care Act requires many health plans to provide coverage for certain recommended clinical preventive services without charging copays or deductible payments. This provision could lead to greater uptake of many services that can improve health and save lives. Although the coverage provision is broad, there are many caveats that also apply. It is important for providers and public health professionals to understand the nuances of the coverage rules to help maximize their potential to improve population health.

Rationale for periodic reporting on the use of selected clinical preventive services to improve the health of infants, children, and adolescents--United States.

This supplement is the second of a series of periodic reports from a CDC initiative to monitor and report on the use of a set of selected clinical preventive services in the U.S. population in the context of recent national initiatives to improve access to and use of such services. Increasing the use of these services can result in substantial reductions in the burden of illness, death, and disability and lower treatment costs. This supplement focuses on services to improve the health of U.S. infants, children, and adolescents. The majority of clinical preventive services for infants, children, and adolescents are provided by the health-care sector. Public health agencies play important roles in increasing the use of these services by identifying and implementing policies that are effective in increasing use of the services and by collaborating with stakeholders to conduct programs to improve use. Recent health-reform initiatives, including efforts to increase the accessibility and affordability of preventive services, fund community prevention programs, and improve the use of health information technologies, offer opportunities to improve use of preventive services. This supplement, which follows a previous report on adult services, provides baseline information on the use of a set of selected clinical preventive services to improve the health of infants, children, and adolescents before implementation of these recent initiatives and discusses opportunities to increase the use of such services. This information can help public health practitioners, in collaboration with other stakeholders that have key roles in improving infant, child, and adolescent health (e.g., parents or guardians and their employers, health plans, health professionals, schools, child care facilities, community groups, and voluntary associations), understand the potential benefits of the recommended services, address the problem of underuse, and identify opportunities to apply effective strategies to improve use and foster accountability among stakeholders.

Relationship of income and health care coverage to receipt of recommended clinical preventive services by adults - United States, 2011-2012.

Each year in the United States, an estimated 100,000 deaths could be prevented if persons received recommended clinical preventive care. The Affordable Care Act has reduced cost as a barrier to care by expanding access to insurance and requiring many health plans to cover certain recommended preventive services without copayments or deductibles. To establish a baseline for the receipt of these services and to begin monitoring the effects of the law, CDC analyzed responses from persons aged ≥18 years in the National Health Interview Survey (NHIS) for the years 2011 and 2012 combined. This report summarizes the findings for six services covered by the Affordable Care Act. Among the six services examined, three were received by less than half of the persons for whom they were recommended (testing for human immunodeficiency virus [HIV] and vaccination for influenza and zoster [shingles]). Having health insurance or a higher income was associated with higher rates of receiving these preventive services, affirming findings of previous studies. Securing health insurance coverage might be an important way to increase receipt of clinical preventive services, but insurance coverage is not all that is needed to ensure that everyone is offered and uses clinical services proven to prevent disease. Greater awareness of Affordable Care Act provisions among public health professionals, partners, health care providers, and patients might help increase the receipt of recommended services.

The Patient Protection and Affordable Care Act: opportunities for prevention and public health.

The Patient Protection and Affordable Care Act, which was enacted by the US Congress in 2010, marks the greatest change in US health policy since the 1960s. The law is intended to address fundamental problems within the US health system, including the high and rising cost of care, inadequate access to health insurance and health services for many Americans, and low health-care efficiency and quality. By 2019, the law will bring health coverage--and the health benefits of insurance--to an estimated 25 million more Americans. It has already restrained discriminatory insurance practices, made coverage more affordable, and realised new provisions to curb costs (including tests of new health-care delivery models). The new law establishes the first National Prevention Strategy, adds substantial new funding for prevention and public health programmes, and promotes the use of recommended clinical preventive services and other measures, and thus represents a major opportunity for prevention and public health. The law also provides impetus for greater collaboration between the US health-care and public health systems, which have traditionally operated separately with little interaction. Taken together, the various effects of the Patient Protection and Affordable Care Act can advance the health of the US population.

Delivering new vaccines to adolescents: the role of school-entry laws.

In the United States, state-based school-entry vaccination laws have been used effectively to rapidly increase vaccination rates among adolescents, in particular, for hepatitis B vaccine. New vaccines for adolescents raise the question of whether and under what circumstances school-entry laws may be used to increase coverage rates with these vaccines. The new vaccines differ somewhat from their predecessors and raise policy and legal issues. For example, some of the new vaccines prevent diseases for which the primary mode of transmission is sexual contact. Mandating these vaccines before school entry has been met with concern by those who believe that mandates for this type of vaccine not only intrude on parental decision-making rights but might also lead to sexual promiscuity among youth. In this article we explore (1) the possible utility of school-entry requirements to increase the delivery of the new vaccines for adolescents, including the legal basis for US school-entry laws, (2) arguments in favor and concerns about the adoption of laws for adolescent vaccination, and (3) the importance of including diverse stakeholders in the deliberative process and formulating and implementing laws in a way that maximizes their acceptance and effectiveness.