Impact of the Affordable Care Act on the Cooper Women’s Care Center

Background: The Affordable Care Act (ACA) increased access to women’s health care by expanding Medicaid eligibility and requiring that insurance plans cover many gynecologic preventive services at no cost to patients. Before implementation of the ACA, pregnant women with low incomes qualified for Medicaid but childless adults of the same income did not, and though prenatal obstetrical visits were covered by plans at no or low cost to patients, most gynecologic services required out of pocket payments. Objective: This study aimed to identify changes in the types of visits (gynecologic or obstetric) and patient demographics (including age, race, and insurance type) at the Cooper Women’s Care Clinic (WCC) as markers of the impact of the ACA. Methods: This is a cross-sectional study that utilized billing data from the Cooper WCC to understand the changes in visit type and demographics (age, race, and insurance type) over two pre-selected time periods, pre-ACA (2005-2009) and post-ACA (2011-2015). Our primary outcome was the proportion of total visits for each time period that were gynecologic vs. obstetrical. Our secondary outcomes were patient demographics, including age, race, and insurance type. Results: The proportion of gynecology visits in the post-ACA time period increased (71.4%) compared to the pre-ACA time period (62.7%), a statistically significant change (p\u3c0.0001) Conclusions: Our study demonstrates measurable changes that occurred in an urban Ob/Gyn practice as a result of the implementation of the ACA. Using gynecology visit volume as a marker of expanded access to Medicaid and free preventive services, it is clear that the ACA is changing the type of care provided by ob/gyns