While a federal judge has struck down some of the preventive care mandates in the Affordable Care Act (ACA), insurers said they plan to stay the course on coverage.
Judge Reed O’Connor blocked the enforcement of recommendations made by the U.S. Preventive Services Task Force. The ACA requires no-cost coverage for breast and cervical cancer screenings, diabetes screening, and vision tests for preschool-aged children, and it includes free coverage for pre-exposure prophylactic (PrEP) drugs, which prevent HIV.
"The Braidwood decision, if implemented, would erode access to an entire range of preventive health services—from cancer screening to HIV prevention to preeclampsia screening for expecting mothers," Meg Murray, the CEO of the Association for Community Affiliated Plans (ACAP), told Fierce Healthcare in an email. "Families deserve better than having bedrock protections of the health reform law invalidated with a two-page ruling.”
ACAP represents 78 not-for-profit health plans.
“We call on the Justice Department to appeal this ruling such that this decision can be stayed to give the necessary acts of jurisprudential hygiene time to occur,” said Murray. “In the interim, our Safety Net Health Plans will continue to work to equitably improve the health of all their members—regardless of their sexual orientation or their gender identity.”
O’Connor issued a summary judgment in the case in September. At the time, the decision applied only to the employers that brought the case. Yesterday’s ruling expands that to all employers and insurers nationwide.
O’Connor—of the U.S. District Court for the Northern District of Texas—stated that the Task Force, a body of volunteer primary care experts, isn’t subject to Senate confirmation, which invalidates its coverage recommendations.
The ruling is almost certain to be challenged in the courts, experts said.
David Merritt, the senior vice president of policy and advocacy for the Blue Cross and Blue Shield Association (BCBSA), said in a statement that “the value of preventive services cannot be overstated: Access to no-cost screenings, counseling services and preventive medications is critical to improving overall health, early detection, and breaking down barriers to care.”
Merritt said he wants beneficiaries to know that BCBSA coverage of preventive services will not change because of O’Connor’s ruling.
“Blue Cross and Blue Shield companies strongly encourage the Americans they serve to continue to access these important services to promote their well-being,” Merritt said. “We will continue to monitor further developments in the courts.”
Matt Eyles, president and CEO of AHIP, the health insurance industry’s leading lobbying group, said in a statement that “as we review the decision and its potential impact with regard to preventive services recommended by the U.S. Preventive Services Task Force, we want to be clear: Americans should have peace of mind there will be no immediate disruption in care or coverage.”
Eyles added that AHIP fully expects “that this matter will continue on appeal, and we await the federal government’s next steps in the litigation, as well as any guidance from relevant federal agencies.”
Ceci Connolly, the president and CEO of the Alliance of Community Health Plans (ACHP), a not-for-profit organization representing health insurance plans and provider organizations, said in a statement that ACHP “has long been supportive of the Affordable Care Act, including the preventive benefits that make care more affordable and accessible to millions of consumers. Cutting these critical preventive benefits, such as zero-cost cancer screenings and immunizations, would have a severe impact on health care across the country.”
Richard G. Stefanacci, of Jefferson College of Population Health at Thomas Jefferson University, told Fierce Healthcare in an email that the “primary reason to have copayments is to prevent moral hazard defined as inappropriate utilization."
"For these types of preventive services where all utilization following guidelines is considered appropriate moral hazard concerns should not apply," he said. "In addition, since there is typically a very positive ROI to insurers for covering preventive services it makes financial sense for them to continue to cover these services without copayments.”
He added that “long-sighted insurers will continue to cover with no copayment.”