• Lois Kaye Lee, Michael Carl Monuteaux, and Alison Amidei Galbraith.
• Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts. Electronic address: lois.lee@childrens.harvard.edu.
• Am J Prev Med. 2019 May 1; 56 (5): 631-638.

IntroductionWomen historically have had difficulty maintaining health insurance, obtaining preventive care, and affording care. The objectives of this study were to describe changes in insurance affordability, healthcare access, and preventive care for women of different income levels after implementation of the Affordable Care Act.MethodsThis was a difference-in-differences analysis of data about U.S. women aged 19-64years from the National Health Interview Survey. This study examined self-reported insurance affordability, access to health care, and preventive services. Changes before (2010-2013) and after (2014-2017) the Affordable Care Act insurance expansions were compared by income (≤138% federal poverty level vs≥400% federal poverty level). Multivariate difference-in-differences analyses adjusting for demographics were expressed as risk differences.ResultsThe sample represented an estimated 41,106,929 women. After the Affordable Care Act, women with incomes ≤138% federal poverty level, compared with ≥400% federal poverty level, had less difficulty finding affordable insurance (adjusted difference-in-differences: -27.18, 95% CI= -36.37, -18.00); were more likely to have seen/talked to a doctor in 12 months (adjusted difference-in-differences: 3.08, 95% CI=1.29, 4.87), had blood pressure screening (adjusted difference-in-differences: 3.27, 95% CI=1.94, 4.60), cholesterol screening (adjusted difference-in-differences: 5.05, 95% CI=2.45, 7.64), and mammograms (adjusted difference-in-differences: 6.87, 95% CI=3.94, 9.79).ConclusionsAfter implementation of the Affordable Care Act, women in all income groups, especially the lowest, reported greater affordability of coverage, access to health care, and receipt of preventive services. Efforts to alter the Affordable Care Act should consider the impact of policy changes on women's health and preventive care.Copyright © 2019 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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