March 31, 2023 – Health experts across the country are scrambling to determine which preventive services may no longer be free for patients after Thursday decision by a Federal Court judge who struck down part of the Affordable Care Act.
U.S. District Court Judge Reed O’Connor ruled that the ACA’s prevention mandate, which provides for screenings for multiple conditions, from lung cancer to sexually transmitted infections, at no cost, violates the plaintiffs’ religious rights and is unconstitutional.
Meanwhile, health experts were researching exactly how many preventative services might be affected and said no changes were likely to happen immediately. The Justice Department filed a notice on Friday saying it was considering an appeal.
Many health and other organizations have reacted strongly against the decision while acknowledging that no changes are expected immediately.
In a statement, the American Academy of Family Physicians said it was “alarmed and disappointed” by the decision and said it would “create insurmountable barriers to preventive testing, counseling and medication that improves patient and population health, including pre-exposure prophylaxis (PrEP) drugs for HIV prevention.
Margaret A. Murray, president of the Association for Community Affiliated Plans, which represents 79 health plans that provide coverage to more than 25 million people, said in a statement that the decision, if implemented, would reduce access to a range of preventive health services. “Families deserve better than to have basic health reform law protections struck down by a two-page ruling.”
The O’Neill Institute for National and Global Health Law at Georgetown University made clear that the decision could skyrocket the costs of important preventive services.
“Unless suspended, the ruling will make preventative health services unaffordable for millions of Americans and limit their ability to get early treatment for diseases such as colorectal and lung cancer, diabetes and depression, to name a few,” the band said in a statement.
Legal experts said a stay of the case, known as Braidwood v. Becerra, could be granted until the appeal is decided so that the services remain in place.
“It could even go all the way to the Supreme Court,” said Cynthia Cox, vice president and program director of the Affordable Care Act for the Kaiser Family Foundation, a nonprofit focused on health issues. nationals.
What treatments are involved?
Under the ACA, preventive services that have an A or B rating from the US Task Force on Preventive Services, a voluntary, independent group of experts, are covered at no cost. Over the years, the USPSTF has given 53 A or B grades covering 46 recommendations.
The ruling holds that the Preventive Services mandate is unconstitutional because it violates provisions of the US Constitution. Appointment clause. This clause requires that such decisions be made by a federal official appointed by the president or a department head. The task force is an independent group of volunteer experts who comb through the evidence before making their recommendations.
According to the court’s decision, only recommendations issued in 2010 or later, when the ACA went into effect, would be overturned. Although the USPSTF website does not have a listing of the number of A or B ratings issued (or upgraded to A or B) since 2010, Cox estimates that about a dozen would potentially be removed.
At a Kaiser Family Foundation seminar on the decision on Thursday, Cox and other experts speculated that some of the new recommendations, such as screening for lung cancer and skin cancer, as well as a recommendation to provide free cholesterol-lowering statins to people at risk, may no longer be entirely free.
However, “I think it’s very likely that insurers will still cover” these programs, said Larry Levitt, Kaiser’s executive vice president for health policy, but cost-sharing with a copay could be added. to certain services.
“This decision does not affect vaccines,” Cox said. Recommendations for vaccines come from the CDC’s Advisory Committee on Immunization Practices. Pregnancy care should also not be affected, Cox and other experts said. One exception, she says, might be screening for perinatal depression.
“There’s a lot of concern about what this could mean for access to care,” Cox said. “Even a small cost-sharing [amounts] can deter people from seeking preventive care.
In the coming days, more clarity is expected on which preventive services are remaining and which are not, she said.
Until more is known, Cox urged people to remember that “the list of services that remain free is much longer than the list that could be subject to cost sharing.” Her advice: “Don’t panic and still get the preventative care that is recommended for you.
Levitt and other experts said coverage changes were unlikely to happen immediately because the insurer’s contracts are typically in place for the year.
Changes will likely come, if the ruling stands, next calendar year, Levitt said. Beyond the ACA, states are free to require coverage for these services, he said, and some do. “But states can’t achieve self-insured plans, which cover most people.”
Until the legal arguments are settled, there are a number of steps people can take, said Meredithe McNamara, MD, assistant professor of pediatrics and adolescent medicine specialist at Yale University School of Medicine, who studied the effect of eliminating coverage for the HIV prevention drug known as PrEP.
- Contact your health care provider to discuss how this may affect care.
- Call the insurers and demand continued access to preventive care without cost sharing.
- Contact elected officials and ask for a federal workaround.
Preventive services “get people out the door,” she said, and provide valuable health advice.
The US Task Force on Preventive Services makes its recommendations based on medical evidence that certain services help prevent the spread of disease or improve treatment through early detection.
“If cost becomes a barrier to preventive care, it could lead to worse health outcomes, whether it’s late-stage lung cancer diagnoses or increased HIV transmission,” Cox said. .