The Affordable Care Act and the opportunity to improve prevention in women: how to make the most of the law.

Preventable chronic illnesses cause 7 of 10 American deaths each year and account for 75% of US healthcare spending (1). Women are disproportionately affected by chronic disease, which negatively impacts their quality of life and their economic status (2). Women’s major chronic illnesses are estimated to cost about $466 billion per year, which does not include lost potential income and additional economic impact to women and their families (2). Prevention and access to preventive services are critical to maintaining a woman’s health across the lifespan. Women’s preventive care is especially important for the health of future generations given the direct impact a woman’s health has on birth outcomes. Yet, despite the importance of preventive care, more than half of American women are not up to date on recommended preventive services (3). A major barrier to preventive care is cost. Women use more healthcare services than men, due in part to more complex reproductive healthcare needs, longer life expectancies, and higher rates of chronic disease (4, 5 ). Yet women often have lower mean incomes and greater difficulty affording care. Even minimal levels of cost sharing, in the form of copays and other out-ofpocket expenses, may have a negative impact on the utilization of preventive services (3 ). Fortunately, the Affordable Care Act (ACA) takes a number of steps to improve health through a robust prevention policy. At the centerpiece of the ACA’s prevention initiative is the elimination of cost sharing for many preventive services, including 8 key women’s health preventive services recommended by the Institute of Medicine (IOM) and adopted by the US Department of Health and Human Services (HHS) on August 1, 2012 (Table 1). Prevention and early detection of health conditions or diseases identified during a wellwoman visit and regular preventive screenings can lead to effective treatment and improved health outcomes (6). Consequently, as national and state health reform implementation under the ACA moves forward, important challenges and opportunities arise to protect and improve women’s access to preventive care and increase its quality while decreasing costs. Here we outline some of these opportunities and challenges, make recommendations for what we believe would improve women’s access to preventive services, and document the impact of this landmark legislation on women’s health.