Insurance Coverage, Provider Contact, and Take-Up of the HPV Vaccine

Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States and the single biggest cause of cervical cancer, as well as certain cancers of the head and throat, anus, vulva, vagina, and penis. Between 2008 and 2012 nearly 40,000 people annually were diagnosed with an HPV-related cancer. Despite these staggering numbers and the existence of a highly effective vaccine, HPV vaccination rates remain low. In this paper, I show that state Medicaid expansions as part of the Affordable Care Act were associated with a 3-4 percentage point increase in the probability that a teenager initiated the HPV vaccine. This relationship appears to have been driven in part by increases in Medicaid coverage, the probability of having a recent checkup, and knowledge about the HPV vaccine. Supporting this pathway, I show that Medicaid expansion states saw increased searches for "pediatrician," "Gardasil" (a trade name of the HPV vaccine), and "HPV cancer."