What will happen if Obamacare is repealed? You could pay a lot more for preventive care
Cancer screenings, birth control, and even the shingles vaccine could be seriously pricey
Yesterday, the Senate took its first major step toward repealing Obamacare (aka the Affordable Care Act or ACA). With so many important health care provisions at risk of being dismantled, there’s a lot at stake. If it’s repealed but not replaced, 20 million Americans who gained coverage through the exchange could lose their health insurance altogether.
That’s cause for concern. But even if you aren’t buying insurance on the exchange, you could still be affected by a number of lesser-known ACA reforms, including preventive care coverage.
177 million people—well over half of all insured Americans—have private health insurance or insurance through their employers. They can get cancer screening, birth control, vaccines, and other preventive care at zero out-of-pocket cost thanks to the ACA. The law requires insurance companies—not patients—to pay 100% of the cost for those routine health services (although it doesn’t always work out that way).
If the ACA is repealed, there’s a chance that these preventive care services would no longer be covered by insurance companies. If that happens, the costs could be passed on to you. And since 51% of privately insured workers have an annual deductible of $1,000 or more, routine care could max out your wallet.
We looked at Amino’s database, which covers nearly every doctor in America and costs for common medical services, to determine how much the most common big-ticket preventative services could cost post-ACA, including:
An intrauterine device (aka an IUD, a form of birth control)
Tubal ligation (aka “getting your tubes tied,” a form of sterilization)
We found that costs could range from about $267 for a screening mammogram to $4,000 for tubal ligation. Alaska stood out as the most expensive state for multiple items, including screening mammograms, shingles vaccines, and Mirena IUDs. And on average across the US, getting a Mirena IUD could cost more than $1,000.
If you’re interested in how we determined these prices, click here to read about our methodology.
A colonoscopy is an examination of the large intestine to check for colorectal cancer, usually performed by a gastroenterologist. Colonoscopies can be either preventive screenings (before you’ve experienced symptoms) or diagnostic (if you’ve experienced symptoms or have a personal or family history of cancer). Under the ACA, insurers must cover 100% of the cost of screening colonoscopies, but not diagnostic ones—you can read more about that in our article on colonoscopy costs.
Screening colonoscopies are very common—and necessary. The CDC recommends that all adults get one every 10 years, beginning at age 50.
Amino’s current median network rate estimate for a screening colonoscopy is $1,628. Pennsylvania had the lowest estimated cost ($1,169) and Minnesota had the highest ($2,567).
Mammograms are X-ray images used to check for breast cancer. They can be for screening (as a routine check up) or diagnostic (if you show signs of breast cancer). Under the ACA, insurers must cover 100% of the cost of screening mammograms, but not diagnostic ones—we explain this in further detail in our article about mammogram costs.
Because early detection of breast cancer can be life-saving, all women need to get screening mammograms at some point. The American College of Obstetricians and Gynecologists recommends starting annual mammograms at age 40. Other groups, like the American Cancer Society, have more detailed age recommendations.
Amino’s current median network rate estimate for a screening mammogram is $267. Utah had the lowest estimated cost ($157) and Alaska had the highest ($496). Interestingly, Alaska is the most expensive state for IUDs and shingles vaccines, too.
Intrauterine devices (or IUDs) are a long-term form of female birth control, usually prescribed by a gynecologist. There are lots of types and brands to choose from, but Mirena is one of the most popular (in our birth control study, we found that more women choose Mirena than Paragard and Skyla combined).
Amino’s current median network rate estimate for a Mirena IUD is $1,111. Washington D.C. had the lowest estimated cost ($936) and Alaska had the highest ($1,586). Alaska is the most expensive state for routine mammograms and shingles vaccines, too.
As we explain in our article about Mirena costs, the breakdown of costs are as follows:
Estimated cost for the IUD device: $839
Estimated cost for the procedure: $107
Estimated cost for office visit: $91
Other estimated costs: $74
The largest portion of the cost ($839) comes from the device itself. Currently, as long as you have insurance, the ACA should always cover that charge. So without the ACA, getting an IUD could be much more expensive.
Tubal ligation, often called “getting your tubes tied,” is a surgical procedure where a woman’s fallopian tubes are tied or cut. Like a vasectomy (for men), it’s a permanent form of birth control (but for women).
Amino’s current median network rate estimate for a tubal ligation is $4,002—that’s more than all the other preventive services we looked at. Arkansas had the lowest estimated cost ($3,059) and Wyoming had the highest ($6,900).
Shingles is a non-life threatening but often debilitating disease caused by varicella-zoster, the same virus that causes chickenpox. The vaccine can help prevent or treat the disease, and the CDC recommends you get it if you’re over age 60. Usually, the shingles vaccine is given to adults by their family practitioner.
Amino’s current median network rate estimate for the shingles vaccine is $366. Currently, your insurance company is supposed to pay 100% of the cost—but if the ACA is repealed, this cost could be passed on to you.
As outlined in our post on shingles vaccine costs, the breakdown of costs are as follows:
Estimated cost for the office visit: $127
Estimated cost for the procedure: $239
Most of the cost comes from the procedure itself (not the office visit). Currently, as long as you have insurance, the ACA should always cover that charge. So without the ACA, your cost could increase.
Although the ACA requires health plans that started on or after September 23, 2010 to cover 100% of preventive care costs, it doesn’t always work out that way. You may have experienced this firsthand if you’ve had a screening colonoscopy or mammogram done recently. Chances are, it wasn’t free.
Unfortunately, this happens pretty frequently for a variety of reasons, including:
What medical code the doctor uses when they bill your insurance for the procedure. According to the Kaiser Family Foundation, the problem is that “no consistent coding methodology is used” by private insurers or doctors to identify the preventive care and screening services that the ACA covers.
Charges for related services that are actually necessary. If you get an IUD, the device itself might be free, but you could be charged for the office visit or associated services, like a pelvic exam.
If a problem comes up during your screening, it may change from a screening procedure (which is covered under the ACA) to a diagnostic one (which is not). This is quite common during colonoscopies, since polyps are often detected and removed.
Insurance wrongfully denying a service that should be covered. Unfortunately, this is one of the top five most common billing errors, according to Remedy, a company that finds mistakes on medical bills and negotiates with your insurance to save you money. “The most common type of billing error we see in preventative services is copays for annual wellness services that should be free of charge to the patient,” said Marija Ringwelski, Remedy’s COO. For example, Remedy says that immunizations are often wrongfully denied by insurance, and sexually transmitted infection (STI) screenings are often over-billed. Both are preventative services that should be free of charge to the patient.
Unexpected costs are always frustrating. To minimize your out-of-pocket costs, make sure to ask your doctor and insurance company if your coverage includes the visit, the screening procedure itself, and any medication you’ll need afterwards. Don’t forget to ask if the amount could change based on findings during the procedure—it’s best to know beforehand, even if everything turns out to be normal.
Even though preventive care isn’t completely free today, the ACA helped lower the cost of essential health services for millions of people. If Congress repeals it without a replacement, you might see your costs rise. You can use Amino’s free cost estimate tool as a guide to help you understand how much preventive services cost in your area, what goes into the total cost, and how much you might be responsible for out-of-pocket—but you should always double check with your doctor and insurance company.
Amino's database has billions of health insurance claims from 129 insurance companies, which means we're able to show cost estimates for common medical procedures, doctors, insurance companies, and geographic regions.
We call our cost estimate the network rate estimate—this is how much you and your insurance company together would pay a doctor or hospital for a procedure. You can learn all about how we determine our network rate estimates here. For this article, we looked at the median network rate estimates for each state and the country as a whole.
We can hypothesize that if the ACA is repealed and insurance no longer covers their portion of the costs, the total cost Amino currently shows could be passed down to you. However, your actual out-of-pocket costs for any of these procedures could be influenced by many factors, including your insurance plan design (like your deductible, co-insurance, and co-pay).
Keep in mind that no one knows for sure what will happen if the ACA is repealed. Perhaps insurance companies will step in and keep preventive care covered, or states will enact their own laws. Plus, it’s entirely possible Congress will only repeal part of the ACA—or not repeal it at all.
Analysis and data visualizations by Sohan Murthy