Patients are likely to avoid preventive care should ACA coverage ruling stand, survey finds

If the courts dismantle a list of no-cost preventive care services under the Affordable Care Act (ACA), it would likely lead many patients to skip out on care, according to a new survey from Morning Consult.

The organization polled (PDF) a representative sample of 2,199 adults and found that more than half would be unwilling to pay for a number of preventive services if their insurance no longer covered them. For example, 60% said they would not pay for smoking cessation or screenings for unhealthy drug use.

In addition, 58% said they would be unwilling to pay for weight loss measures to address health risks tied to obesity, and 53% said they would not pay for depression screenings. Fifty-two percent said they would not pay for HIV screenings if their insurance no longer covered them.

About a quarter (23%) of those surveyed said preventive care is one of the most important services for health plans to over.

A Texas judge ruled last fall that the current process for determining which preventive services are covered at no cost under the ACA is unconstitutional. Judge Reed O'Connor also previously kicked off a legal showdown over the ACA itself, which made its way to the Supreme Court.

O'Connor ruled that Congress' decision to zero out the ACA's individual mandate penalty rendered the law unconstitutional in full. SCOTUS disagreed and preserved the law in a 7-2 decision.

O'Connor's ruling on the ACA's preventive services is also likely to face a long legal road, experts said.

Morning Consult's survey found that at least 2 in 5 U.S. adults would not be willing to pay for 11 of the 12 preventive services currently covered under the ACA should that coverage end. The survey respondents were more likely to pay for certain critical services, such as cancer screenings, which 46% said they'd still pay for.

However, 38% of respondents said they would not be willing to pay for cancer screenings if they weren't covered.

Preventive care was among the top five services that the respondents believe are important for insurers to cover, according to the survey, coming in at fourth. By comparison, 33% said that emergency care is one of the most important service to be covered, and 28% said the same about prescription drugs.

In addition, 25% of those surveyed said hospitalizations are the most important for insurers to cover, and 17% said mental health and substance abuse services.

Concerns about the future of preventive care coverage come as the industry is already grappling with high costs. Research suggests that costs lead patients to skip care, and the Morning Consult survey underscores this finding, with 50% of those surveyed saying they've avoided care due to cost.

Thirty percent of those surveyed said they skipped care in the past year, and 20% said that they did so more than a year ago. Passing on care because it was too expensive was most common among people with incomes under $50,000 per year, according to the survey.