Texas Judge Strikes Down Required Coverage of Preventive Care

In 2018 I was invited by A. Mark Fendrick MD to sit on the Board of The University of Michigan’s Center For Value Based Insurance Design as a Patient Advocate.?

The mission?of the?VBID Center?is to increase access to high value medical care advocating for initiatives to reduce financial?barriers to evidence based services. ???

As someone who spends most of her waking hours advocating for patients, I am concerned that millions of Americans, many of them will no longer seek preventative care due to cost sharing.??

The following press release details today’s ruling:

Thursday, March 30:?Judge Reed C. O’Connor, of the U.S. District Court for the Northern District of Texas,?granted Braidwood Management Inc.'s request?to block Section 2713 of the?Public Health Service Act as amended by the ACA, that?requires coverage without cost-sharing of preventive services to which the?U.S. Preventive Services Task Force (USPTF) assigns a rating of “A” or “B”.??

Judge O’Connor ruled that USPSTF recommendations are unconstitutional because the task force members are not appointed by the President and confirmed by the Senate.?

Section 2713 is one of the?most popular?provisions in the ACA, and has increased screenings,?improved health outcomes, and reduced racial disparities?in health care access. The U.S. Department of Health and Human Services estimates?152 million Americans?have had access to additional preventive care with zero cost-sharing, especially among Black Americans, Latinos, Asian Americans and Pacific Islanders, American Indians/Alaska Natives, and individuals living in states that expanded Medicaid.?

In their?Health Affairs Forefront article?on the ruling, University of Michigan's Nicholas Bagley and A. Mark Fendrick?believe that "requiring patients to pay significant amounts out-of-pocket for high-quality preventive services shouldn’t be a partisan issue. Whether you’re a Democrat or a Republican, it’s just good policy to promote access to services that have been proven to prevent diseases or to detect conditions while they’re still treatable."?

They state that?Congress could easily?put the popular law on an unassailable constitutional foundation with a single sentence, by giving the final authority regarding the USPSTF recommendations to HHS Secretary Becerra.??

Imposing cost-sharing for preventive services would reverse a growing movement among employers in recent years to expand coverage of clinically effective care without deductibles or copays. It also could hamper intensifying efforts to reduce health disparities for lower income Americans, people of color, and the LGBTQ+ population.?

Recent evidence?suggests that the implementation of out-of-pocket costs would have a minimal impact on aggregate employer health care spending, and research indicates that?80% of employers won’t impose cost-sharing?on preventive services now that the ACA preventive services mandate has been overturned.???

Read the ruling?here.?

Read the?Health Affairs Forefront article?here.?