Preventive Services and Barriers to Care for Teens and Young Adults

The below is a summary and citations of the material in the Prezi above (also found here).

The Affordable Care and Patient Protection Act of 2010 (ACA) sought to reform the U.S. health care system, make health care more affordable, and extend health insurance to those who were not covered.

The ACA strengthened insurance regulations for employers, and set up “exchanges” for the purchase of private insurance. Eight million individuals have signed up for health insurance under the ACA – over a quarter of them under age 35. [1] During open enrollment periods, eligible individuals may enroll here.

The ACA covers sexual health services like contraception and screening for sexually transmitted infections with no cost-sharing. But some young people experience difficulty receiving those health services.[2]

Young people have the right to lead healthy lives. They need tools and services to protect themselves from  unintended pregnancy, HIV, and STIs. Many stand to gain from increased access to preventive services.

• 70% of pregnancies among unmarried women in their 20s are unintended.[3]
• 750,000 teens experience pregnancy each year.[4]
  • Reliable and affordable contraception helps young people prevent unintended pregnancy. In Colorado, the teen birth rate dropped 40% due in part to a program which provided young women with low-cost long acting reversible contraception (LARCs).[5]
• 1000 young people per month acquire HIV. 1 in 4 new HIV cases occurs among young people. [6]
• Young people ages 15-24 acquire almost half of all new STI infections (that’s over 9 million STI infections among young people). [7]
  • Young people need access to STI screening to help them treat STIs as early as possible and reduce chances of passing along to a partner.

ACA to the Rescue?

The ACA requires insurers to cover all approved contraceptive methods (pill, patch, ring and LARCs), STIs screening and counseling, immunizations, and other preventive services. [2]

• Who must cover:  group and individual markets, fully- and self-insured plans, as well as student plans and the Medicaid expansion group.
• Exceptions:  grandfathered plans; church plans with religious objections; self funded student plans

35% of people who enrolled in ACA exchanges were under age 35.[1]

Many women are benefiting from contraception coverage.[8]

• 1 in 3 women say private plans covering full cost of contraceptives
• 1 in 3 say insurance covering part of the cost of contraceptives
• 1 in 10 say a public program like Medicaid covering contraceptive needs
• 1 in 5 women continue to lack any coverage.

Women with LARCs (long-acting reversible contraception, like the IUD) have not experienced a decrease in cost.[9]

Many people are not talking about sexual health. Only 1/2 of female patients and 1/4 of male patients discussed pregnancy prevention or STI screening during last clinician visit.[10]

Barriers to care still exist for many young people.

• Lack of awareness. Young adults are the least likely to be aware of health insurance marketplaces in general.
• Confidentiality Concerns. Some plans send an explanation of benefits (EOB) to the policyholder (a parent) rather than allowing the patient to decline an EOB or personally receive the paperwork. Young people may pay out of pocket, turn to a public program, or forgo screening or contraception altogether due to privacy concerns.
• Provider Discomfort. Providers are responsible for delivering recommended screenings and creating a youth-friendly clinical environment, but many do not.
  • Patient Discomfort. Lack of knowledge and discomfort keep adolescents from seeking care.
  • Limited information about STI testing
  • Not knowing where to go for care
  • Fear of stigma or discrimination from their peers or providers
  • Lack of transportation
  • Inconvenient clinic hours
  • Challenges making an appointment and navigating the health system.[11]

Making access real and tangible

Policymakers should work to educate and enroll young people, and raise awareness about the preventive service benefit. They can ensure access to important services by overturning or guarding against threats to confidentiality such as parental consent laws, and by safeguarding against attempts to limit access to sexual health services.

Providers:

• Should only contract with insurance companies that include preventive service coverage in offered health plans, and avoid additional charges to patients for services.
• Must follow clinical guidelines for contraception and STI screening for young people, especially before the onset of sexual activity.
• Must understand consent and confidentiality laws, and meet the practical needs of youth in other ways, such as keeping flexible hours.

Advocates and program planners can also raise awareness about preventive services, and educate young people about care options and clinic locations. They can empower youth to know their confidentiality rights as well as screening recommendations, and advocate for policies that protect privacy and enable better care.

1. White House Office of the Press Secretary.  “Fact Sheet:  Affordable Care Act by the Numbers.”  Accessed 9/4/14 from http://www.whitehouse.gov/the-press-office/2014/04/17/fact-sheet-affordable-care-act-numbers.
2. Contraceptive coverage in the health care law: frequently asked questions. National Women’s Law Center. May 22, 2013. http://www.nwlc.org/resource/contraceptive-coverage-health-care-law-frequently-asked-questions
3. Zolna MR and Lindberg LD, Unintended Pregnancy: Incidence and Outcomes Among Young Adult Unmarried Women in the United States, 2001 and 2008, New York: Guttmacher Institute, 2012.
4. Kost K and Henshaw S. U.S. Teenage Pregnancies, Births and Abortions, 2010: National and State Trends by Age, Race and Ethnicity.  Guttmacher Institute, 2014.
5. Draper E. Birth-control, not abstinence, focus for Colorado teens. Denver Post, 7/15/2014.
6. Centers for Disease Control and Prevention. “HIV Among Youth in the United States.” Accessed 12/18/13 fromhttp://www.cdc.gov/vitalsigns/hivamongyouth/
7. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2011. Atlanta: U.S. Department of Health and Human Services; 2012.
8. Kaiser Family Foundation. Women’s Health Care Coverage. http://kff.org/womens-health-policy/fact-sheet/womens-health-insurance-coverage-fact-sheet/
9. Finer LB, Sonfield A, Jones RK. Changes in out-of-pocket payments for contraception by privately insured women during implementation of the federal contraceptive coverage requirement. Contraception. 2014;89(2): 97–102. http://www.sciencedirect.com/science/article/pii/S0010782413007373
10. Alford S. Best practices for youth friendly clinic services. Advocates for Youth. 2009. https://www.advocatesforyouth.org/component/content/article/1347–best-practices-for-youth-friendly-clinical-services
11. Tilson EC, Sanchez V, Ford CL et al. Barriers to asymptomatic screening and other STD services for adolescents and young adults: focus group discussions.BMC Public Health.2004;4:21. http://www.biomedcentral.com/content/pdf/1471-2458-4-21.pdf