Since its implementation in 2010, the Affordable Care Act has provided new pathways for Americans to access the healthcare services they need. Now, new research from the University of Georgia suggests that ACA policies supporting wellness and prevention can help improve vaccination rates.
The study specifically examined Human papillomavirus (HPV) vaccine uptake before and after the introduction of the ACA. HPV can cause cervical cancer and currently affects more than 79 million people in the United States, and though a vaccine has been available for over a decade, vaccination rates are low.
That could be because the HPV vaccine is expensive, said Rosemary Corriero, who led this study as a graduate student at UGA’s College of Public Health. “HPV is one of the more expensive vaccines, $150 to $200 per dose, and you had three doses in a series. Now there are two doses, but that price still may be prohibitive”
Cost and lack of insurance coverage are known barriers to vaccine uptake, so Corriero had a hunch that the ACA, which provided additional prevention and wellness coverage at no cost and included mandatory coverage of the HPV vaccine, may have had an impact on vaccination rates.
“Studies of other childhood or adolescent vaccines show children who are covered by insurance usually have a higher uptake, and their parents are more receptive because out-of-pocket costs aren’t a factor,” said Corriero.
The team designed a study using data from the National Health and Nutrition Examination Survey (NHANES), including two waves of data prior to the ACA and two years post-ACA. Their analysis included a range of variables known to impact vaccine uptake, including income and education levels.
“We wanted to be able to control for those in our model, so that when we were looking at relationships with insurance coverage and changes in vaccine uptake over time, we could say what change was attributable to insurance coverage,” said Jennifer Gay, an associate professor of health promotion and behavior at UGA’s College of Public Health and corresponding author on the study.
The results showed that participants post-ACA were 3.3 times more likely to get the HPV vaccine, and more people reported completing the full series of vaccinations.
“That’s a pretty big jump,” said Corriero, though she stressed that this relationship doesn’t prove that the increased uptake was a direct result of ACA policies. Other factors could be at play, such as greater awareness about the risks of HPV infection or more doctors recommending the vaccine to patients.
But, said Gay, insurance coverage is a big part of the picture. For those who want the vaccine, she said, “if we can cover it as part of their medical coverage, that will help reduce risk of contracting HPV, which reduces risk of cervical cancer.”
This study points to a trend, said Gay. “Showing the trend is important to know how vaccine rates change over time, and because they could lead to future, longer-term studies looking at causation.”
For the moment, Corriero is happy to see data that points to the positive impact of the ACA. “You hope that something like the ACA that’s so large has an actual impact,” she said. “To have positive results, it was eye opening to see.”
The paper, “HPV Uptake Pre- and Post-Affordable Care Act: Variation by Insurance Status, Race, and Education (NHANES 2006-2014)” published online in the Journal of Pediatric & Adolescent Gynecology and is available at https://doi.org/10.1016/j.jpag.2017.07.002.
Co-authors on the study include Sara Wagner Robb, PhD, and Ellen W. Stowe, MPH.
– Lauren Baggett
Posted September 29, 2017.
Additional coverage in the Sept. 29, 2017 ASPPH Friday Letter and the Georgia Health News.