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Affordable Care Act’s Preventive Services Coverage Mandate and Receipt of Fluoride Varnish.
| Pediatrics | Kranz AM, Mizushima Y, Dick AW, Geissler KH, Gracner T. | 154(5).
Affordable Care Act Federal policy Rand Corporation U.S. Other

Abstract

Video Abstract at the top of abstract

BACKGROUND AND OBJECTIVES

The Affordable Care Act required private insurers to cover a set of recommended preventive services without cost-sharing. This included coverage of fluoride varnish (FV) applications without cost-sharing for children aged 1 through 5 during medical visits, an evidence-based treatment that prevents tooth decay. We examined if this coverage mandate was associated with more young children receiving FV.

METHODS

Using the Massachusetts All-Payer Claims Database (2014–2018), we examined the likelihood that a privately insured child received FV during a medical visit in a month. We used a difference-in-differences approach, comparing those included in the coverage mandate (aged 1–5) to those excluded from the mandate (aged 6–9), before and after the mandate was enacted (January 2015). We repeated analyses in children with Medicaid because this mandate may have had spillover effects for this population.

RESULTS

Among children aged 1 through 5 years with private insurance, 1-year postmandate the probability of FV receipt in a month increased 0.16 percentage points more relative to December 2014 (premandate) compared with the change among children aged 6 to 9 years (P < .001; 95% confidence interval = 0.1–0.22). When examining spillover to children with Medicaid, the mandate was not associated with a significant increase in the probability of monthly FV receipt 1-year postmandate.

CONCLUSIONS

This Affordable Care Act mandate requiring coverage of FV without cost-sharing was associated with higher rates of young children receiving FV in medical settings, with the largest result observed among children with private insurance.

AUTHORS & AFFILIATIONS:

Ashley M. Kranz, PhD
RAND Corporation, Arlington, Virginia

Yuji Mizushima, MPhil, MA
RAND Corporation, Santa Monica, California
Pardee RAND Graduate School, Santa Monica, California

Andrew W. Dick, PhD
RAND Corporation, Boston, Massachusetts

Kimberley H. Geissler, PhD
Department of Healthcare Delivery and Population Sciences, UMass Chan Medical School-Baystate, Springfield, Massachusetts

Tadeja Gracner, PhD
RAND Corporation, Santa Monica, California
Center for Economic and Social Research, University of Southern California, Los Angeles, California

ABSTRACT ONLINE AT https://publications.aap.org/pediatrics/article-abstract/154/5/e2024066638/199657/Affordable-Care-Act-s-Preventive-Services-Coverage?redirectedFrom=fulltext