Principal research scientist, at the Guttmacher Institute, New York.
Senior research associate, at the Guttmacher Institute, New York.
Perspect Sex Reprod Health. 2018 Sep;50(3):101-109. doi: 10.1363/psrh.12061. Epub 2018 Jun 12.
As federal initiatives aim to fundamentally alter or dismantle the Affordable Care Act (ACA), evidence regarding the use of insurance among clients obtaining contraceptive care at Title X-funded facilities under ACA guidelines is essential to understanding what is at stake.
A nationally representative sample of 2,911 clients seeking contraceptive care at 43 Title X-funded sites in 2016 completed a survey assessing their characteristics and insurance coverage and use. Chi-square tests for independence with adjustments for the sampling design were conducted to determine differences in insurance coverage and use across demographic characteristics and facility types.
Most clients (71%) had some form of public or private health insurance, and most of these (83%) planned to use it to pay for their services. Foreign-born clients were less likely than U.S.-born clients to have coverage (46% vs. 75%) and to use it (78% vs. 85%). Clients with private insurance were less likely than those with public insurance to plan to use their insurance (75% vs. 91%). More than one-quarter of clients not planning to use existing insurance for services indicated that the reason was that someone might find out.
Coverage gaps persist among individuals seeking contraceptive care within the Title X network, despite evidence indicating increases in health insurance coverage among this population since implementation of the ACA. Future research should explore the impact of altering or eliminating the ACA both on the Title X provider network and on the individuals who rely on it.
随着联邦政府的各项倡议旨在从根本上改变或废除《平价医疗法案》（ACA），了解获得 ACA 指导方针下的计划生育服务 Title X 基金资助的客户在保险使用方面的证据对于理解利害关系至关重要。
2016 年，对在 43 个 Title X 基金资助的地点寻求避孕护理的 2911 名客户进行了一项全国代表性抽样调查，评估了他们的特征、保险覆盖范围和使用情况。采用调整抽样设计的独立性卡方检验来确定在人口统计学特征和机构类型方面保险覆盖范围和使用情况的差异。
大多数客户（71%）拥有某种形式的公共或私人医疗保险，其中大多数（83%）计划使用该保险来支付服务费用。外国出生的客户比美国出生的客户更有可能没有保险（46%比 75%），也更不可能使用保险（78%比 85%）。拥有私人保险的客户比拥有公共保险的客户更不可能计划使用他们的保险（75%比 91%）。超过四分之一的客户表示，他们不打算将现有的保险用于服务，原因是有人可能会发现。
尽管有证据表明，自《平价医疗法案》实施以来，计划生育服务的 Title X 网络中的个人的医疗保险覆盖率有所增加，但仍存在保险覆盖范围的差距。未来的研究应探讨修改或取消《平价医疗法案》对 Title X 提供者网络以及依赖该网络的个人的影响。
