With judge's ruling, some employers may cut off no-cost preventive care: survey

Some employers have already followed the advice in a ruling by a federal district court judge in Texas that struck down mandates for no-cost preventive care in the Affordable Care Act and have stopped paying for certain services.

The National Alliance of Healthcare Purchaser Coalitions polled 30 employers who cover 1.5 million workers, and found 72% of respondents expect to continue providing coverage for all preventive services in full as is required in the ACA, while 6% said that they expect to be more selective and 22% did not know how they would approach coverage for preventive care services.

“I wasn’t surprised that 72% of employers indicated that they’re going to continue providing 100% of ACA coverage,” Michael Thompson, National Alliance CEO, told Fierce Healthcare. “But I was a little surprised that 28% said that they were going to be taking a fresh look or didn’t know yet. Even today, we’re hearing that some employers, in light of that ruling, are starting to charge employees to get preventive services.”

In addition, only 14% of employers intend to keep paying for over-the-counter COVID-19 tests when the public health emergency caused by the pandemic ends Thursday, the survey found.

Texas ACA ruling employers
(National Alliance of Healthcare Purchaser Coalitions )

The employers who are taking action do so even as the ruling likely faces a lengthy legal challenge. The Department of Justice last month filed a request with the federal court for a partial stay of the judgment.

That only 14% of employers will continue to pay for over-the-counter COVID-19 tests, and 33% said that they will not provide coverage for COVID-19 vaccines can be seen as the “mainstreaming” of COVID-19, or treating and covering it as any other condition or disease might be treated and covered, Thompson said.

“There are concerns by some employers that to continue to cover COVID tests the way that they were covered during the pandemic will be cost prohibitive,” Thompson said. “A lot of that had to do with the fact that employees were stockpiling these tests because they’re free. They’ve got a bunch of them sitting in their closet somewhere. And they’re not cheap. Employers said they were costing them millions of dollars.”

While the report uncovered hesitancy around coverage for COVID-19 vaccines and treatment, a majority of employers (76%) said the need for vaccination remains—and not just for COVID, as 81% cited an increased urgency around all vaccines.

In addition, employers said they want to educate their employees about the need for vaccinations, but realize that might be difficult due to lack of trust (71% for COVID and 33% for other immunizations), confusion or misinformation (71% for COVID and 29% for other vaccines) and safety and efficacy concerns (57% for COVID and 24% for other shots), according to the survey.

“The concerns around the COVID vaccines carried over to broader vaccination, increasing concerns about trusting any vaccination,” Thompson said. “That compounded with the fact that a lot of people didn’t get vaccinated during the pandemic means that we need to kind of re-escalate our efforts to re-educate on vaccination, and also to strongly encourage people to get up to date again. All of that is in the face of a cultural war that people are trying to stay out of.”

When it comes to educating workers about the importance of vaccinations, employers may have some leverage as 81% of respondents said that workers consider employers to be a trusted source of vaccine information. In addition, 79% of employers have vaccine information rates for their workforce on COVID, and 63% have information on flu vaccinations.

NAHPC chart

Employers will probably not enforce vaccine mandates, taking their cue from a decision earlier this month to end the mandates for federal workers.

“You did see that there was a lot less emphasis on workplace rules going forward around COVID,” Thompson said. “It was pretty high as a communication priority before and it’s significantly less high now. We’re not dealing with a pandemic anymore.”

A majority (62%) said that workers consider health plans to be a trusted source.

Employers also said that it’s not all up to them, with 96% of respondents seeing engagement with primary care as crucial to fostering greater vaccination uptake among workers.