In the United States, young adults who lack health insurance generally either forgo preventive health care services such as contraception and cancer screening or get them through a variety of piecemeal programs and out-of-pocket spending (Callahan and Cooper 2005
). This not only threatens the quality of care they receive but also limits the ability of health care regulators, researchers, and consumers themselves to learn from the care they and others receive.
Under the PPACA, many of these previously uninsured people and services will be covered under Medicaid or a plan offered through a state health exchange. States are empowered to contractually require health plans to collect and report health care data and to meet minimum quality standards. If they do, these plans—and the people and services they cover—will provide an important source of data to learn about and improve care. In implementing the new exchanges, states can take advantage of the existing Medicaid infrastructure to integrate patient care and data collection for beneficiaries across a wide spectrum of incomes.
The PPACA thus has great potential to improve the reproductive health of the US population. Expanded coverage of young adults and the reproductive health services they seek will not only benefit current patients but will allow us to learn and improve care for the benefit of future users. In order for this potential to be realized, data collection, reporting, and quality must be a required part of PPACA implementation. Providers and health plans should be required to report both administrative and EMR-derived clinical data to state and federal authorities while respecting individual patient privacy. State-administered health insurance exchanges, as well as expanded Medicaid programs, must write data reporting requirements into their contracts with plans. While women with employer-based insurance will not immediately be affected by new data reporting requirements, over time more employers may drop coverage and state-based plans may represent a growing share of the total insurance market. Furthermore, employers or states may adopt broader requirements for plans to collect and publicly report health data from employer-based insurance.
Going forward, it will be important for future research to track the availability and use of data under the PPACA. If data are shared with the public, are they used by consumers across spectrums of age, culture, and geography? If so, for what purposes? How do consumers, states, and other stakeholders benefit from the data, and are there any unanticipated effects of data reporting? How can data quality and transparency be improved?
It is my hope that by providing high-quality, usable data to health consumers, payers, plans, providers, and researchers, the PPACA can bring about an expanded, holistic vision of reproductive health care that addresses individuals’ needs across the life span.
I am grateful to Colleen Grogan for mentorship on this topic, especially in the area of state contracting theory, and to Irma Hasham Dahlquist for assistance in preparing the manuscript.