Date of Award


Document Type

Open Access Dissertation


Health Services and Policy Management

First Advisor

Mahmud Khan


Background: The Affordable Care Act (ACA) aimed at making health care affordable and accessible including the use of preventive care services. To achieve these aims, the ACA expanded Medicaid coverage to population with income below 138% of FPL and removed cost-sharing when using preventive care services recommended by the USPSTF. This study tried to assess the impact of these provisions on the rate of mammography and Pap tests among women. Methods: Data was obtained from the Medical Expenditure Panel Survey - Household Component MEPS-HC. A difference-indifference design was used to determine the effect of Medicaid eligibility expansion on the outcomes and a counterfactual analysis was used to determine the effect of removing cost-sharing from preventive care services on the outcomes. Results: The difference-indifference estimate show that likelihood of utilizing mammograms did not change significantly among low-income women after the implementation of the Medicaid expansion (DID coefficient -0.0476 with t-statistics at -1.26), Pap test decreased (coefficient -0.0615, t-statistics -2.76), and Medicaid enrollment has increased significantly among low-income women living in expansion states (coefficient 0.0889 with t-value of 3.68). The counterfactual analysis show that the utilization of mammogram and pap test did not improve following the ACA. Conclusion: The ACA was associated with increased Medicaid enrollment but did not yield near-term improvement in use of mammography and Pap tests among women. Factors beyond health insurance coverage may be important in determining the likelihood of obtaining vi these screening procedures and policy makers should try to identify other barriers to cancer screening services utilization among the low-income women in the USA.


© 2018, Abeer Alharbi