The Affordable Care Act (ACA) was a landmark piece of legislation that changed the American health care system. One of those changes required health insurance plans to offer some preventive services at no cost to patients. This provision of the law is very popular as well as critical for managing chronic conditions and preventing more severe illness. In Massachusetts, 3,343,000 people with private health insurance coverage benefited from preventive services without cost sharing in 2020 alone.
Detecting illness early is beneficial across the board: medical providers are better able to treat disease and patients are better able to manage their chronic conditions. Critically, preventive care saves lives and saves money. Take high cholesterol, for example. High cholesterol is a “silent killer” because symptoms may not manifest until it’s too late. Having high cholesterol puts patients at an increased risk of heart disease, heart failure and stroke. Treating this condition early can give the patient a better outlook and (hopefully) avoid costly surgery and hospitalization.
However, despite the well-established benefits of preventive services, there have been lawsuits challenging this requirement in the ACA. One of the lawsuits, Braidwood v. Becerra, is making its way through the federal courts and has the potential to end up before the United States Supreme Court in the coming years. Today, a federal judge in Texas issued a ruling in the case striking down major portions of the preventive services mandate nationwide. To better understand what is at stake, below is a summary of the preventive services currently covered at no cost for patients and serves the subject of current litigation.
Who decides what services are covered?
Although the text of the ACA required insurance companies offer no-cost preventive services, the exact services were not statutorily defined. However, the law does define four separate categories for preventive care: 1) those that pertain specifically to children and adolescents; 2) preventive services with respect to women and pregnant persons; 3) immunizations; and 4) other evidence-based items or services with a current “A” or “B” rating from the United States Preventive Services Task Force.
To define what services were covered in each of those four categories, Congress delegated the duty to three different agencies: the Health Resources and Services Administration (HRSA), the Advisory Committee on Immunization Practice (ACIP), and the United States Preventive Services Task Force (PSTF). HRSA defined what preventive services are provided at no cost for children and women/pregnant persons, ACIP provided vaccine and immunization recommendations and PSTF provided the broadest recommendations for preventive care. PTSF’s recommendations range from cancer screenings to obesity counseling to cardiac health monitoring. Here is an example of some of the services covered:
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Everyone benefits from utilizing preventive services. After all, detecting illness early benefits individuals and society by either preventing disease outright or treating illnesses before a potentially fatal outcome occurs.
The ongoing litigation in Braidwood v. Becerra threatens the future of no-cost preventive services in the Commonwealth and in the 35 states across the country who do not have state-level protections in the event the federal law is overturned. More on the legal history of Braidwood v. Becerra is coming up in part two of this blog series.
Jessica Marsella was a former HCFA intern during her time as a practicum student at Harvard’s Chan School of Public Health