IntroductionThe Patient Protection and Affordable Care Act of 2010 (ACA) will increase insurance coverage for US citizens and for breast and cervical cancer screening through insurance expansions and regulatory changes. The primary objective of this study was to estimate the number of low-income women who would gain health insurance after implementation of the ACA and thus be able to obtain cancer screening. A secondary objective was to estimate the size and characteristics of the uninsured low-income population and the number of women who would still need National Breast and Cervical Cancer Early Detection Program (NBCCEDP) services.MethodsWe used the nationally representative 2009 American Community Survey to estimate the determinants of insurance status for women in Massachusetts, assuming full implementation of the ACA. We extrapolated findings to simulate the effects of the ACA on each state. We used individual-level predicted probabilities of being uninsured to generate estimates of the number of women who would gain health insurance after implementation of the ACA and to predict demand for NBCCEDP services.ResultsApproximately 6.8 million low-income women would gain health insurance, potentially increasing the annual demand for cancer screenings initially by about 500,000 mammograms and 1.3 million Papanicolaou tests. Despite a 60% decrease in the number of low-income uninsured women, the NBCCEDP would still serve fewer than one-third of the estimated number of women eligible for services. The NBCCEDP-eligible population would comprise a larger number of women with language and literacy-related barriers to care.ConclusionImplementation of the ACA would increase insurance coverage and access to cancer screening for millions of women, but the NBCCEDP will remain essential for the millions who will remain uninsured.

Programs serving people with disabilities create employment disincentives in the form of public health insurance that ties eligibility to an inability to work. In 2009, insurance coverage decreased with employment for working-age people with disabilities. Health reform has the potential to ameliorate these employment disincentives by reforming the private health insurance system and by severing the link between eligibility for public health insurance and an inability to work. The authors predict the impact of the Affordable Care Act on working-age adults with disabilities using a simulation model based on 2009 American Community Survey data from Massachusetts, which enacted a similar reform in 2006. They estimate that more than 2 million adults with disabilities will gain coverage and that coverage rates will be higher among the employed. Although health reform may remove some existing employment disincentives, implementation issues are key determinants to insurance and employment outcomes.