Despite ACA cost protections, most adolescents skip regular checkups

As children move through adolescence, some face health hurdles like obesity, sexually transmitted infections, depression and drug abuse. Regular checkups could help families address such problems, and the Affordable Care Act paved the way by requiring insurers to fully cover well-child visits, at no charge to patients.

But, both before and after the ACA was established, fewer than half of kids ages 10 to 17 were getting routine annual physical exams, according to a recent study.

"Most adolescents are pretty healthy, but a lot of them are headed for trouble with obesity" and mental illness and substance use, said Sally Adams, a research specialist on adolescents and young adults at the University of California-San Francisco, the study's lead author. "These are things that can be caught early and treated, or at least managed."

For the study, published online this month in JAMA Pediatrics, researchers analyzed data from the federal Medical Expenditure Panel Survey, which tracks health insurance coverage and health care use and spending. Researchers used data from 25,695 people who were caregivers of adolescents ages 10-17. About half were surveyed from 2007 to 2009 and the rest from 2012 to 2014.

Before the health law passed in 2010, caregivers reported that 41 percent of children had a well-child visit in the previous year. After the ACA's preventive services protections became effective, typically in 2011, the rate climbed to 48 percent, a "moderate" increase, Adams said. The increase was greatest for minority and low-income groups.

Still, more than half of children in the survey didn't go to the doctor for routine care over the course of a year, even though many families gained insurance and wouldn't have owed anything for the visits.

That's cause for concern, Adams said. A primary care provider can screen youngsters for risky behaviors and treat them if necessary. A checkup is also an opportunity to educate patients on health.

"The behaviors they pick up as adolescents have a strong influence on their adult health across their life course," she said. For example, she noted, "if you can keep them from starting to smoke, then they probably won't smoke."

Young children typically have regular pediatrician visits for recommended vaccines, hearing and vision tests as well as school checkups. But those needs may change as children get older, and state requirements that kids get physicals before entering school vary. Some may require a checkup every year, others only at intervals."Healthcare professionals have told us that rates of well-child visits tend to be lower after the early childhood years,” Adams said.

The ACA required that most health plans cover preventive services recommended by four medical and scientific expert groups without charging consumers anything out-of-pocket. For children, many of these services are spelled out in the Bright Futures project guidelines, sponsored by the American Academy of Pediatrics and supported by the federal government, and by the U.S. Preventive Services Task Force, an independent group of medical experts that evaluates the evidence for clinical care.

About a fifth of adolescents ages 12 to 19 are obese, and between 13 and 20 percent of children have a mental disorder in any given year, according to the Centers for Disease Control and Prevention.

Some research has shown that parents may believe that adolescents do not need to go to the doctor unless they're sick and that they can't afford to pay for checkups, Adams said.

"What we would like is for families to understand that this is a right families have and that these are valuable services that can help their children," she said.

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KHN's coverage of children's health care issues is supported in part by the Heising-Simons Foundation.