Should be preventive care be optional coverage?

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In this article, I’m covering a court ruling on coverage of preventive services. Please read on! 📖 

Federal Appeals Court Rules on the Affordable Care Act’s Preventive Services Mandate in the U.S. District Court’s Decision on Braidwood Management v. Becerra

What happened?

Christian companies with a total of about 70 employees brought a suit against HHS that was ruled in favor of the plaintiffs in 2023. The plaintiffs argued that the mandate to cover certain treatments went against their religious beliefs. Judge Reed O’Connor in Texas ruled that the federal mandate was unconstitutional. An injunction was put on the mandate so it could move the appeals process.

This article in Health Affairs covers interesting facts about the plaintiff and perspectives on the case. Here’s a quote from the article, but I thought it was worth the quick read:

and then 👇️ 

The Appeals Court upheld the suit only for the plaintiffs and coverage for their employees, but agreed with the plaintiff that the United States Preventive Services Task Force (USPSTF) members should be appointed by the President and confirmed by the Senate to have the authority to decide which services must be covered by payers and self-insured employers. Many believe this issue will end up in the Supreme Court because it leaves open the possibility for a broader ruling.

Reporter Maya Goldman of Axios also summarizes the issue well in this article.

Background

One of the Affordable Care Act’s (ACA) most popular provisions requires coverage of preventive services, and that these services must be covered with no cost-sharing (many believe critical to widespread adoption). Additional services can be added on an ongoing basis if they meet the criteria. More on that below.

What services are considered preventive?

The United States Preventive Services Task Force (USPSTF) Levels A and B recommendations must be covered without copay by most insurers.

Examples of preventive services Levels A and B:

• Screening for adult hypertension

• Tobacco smoking cessation

• Preventive interventions for perinatal depression

More here! 👇️ 

Why does this matter?

The Affordable Care Act (ACA) requires new private health insurance plans to cover certain preventive services without cost-sharing. The Department of Health and Human Services (HHS) has the authority to extend this to Medicare, which they do. The lower court’s ruling is not applicable to Medicare beneficiaries’ preventive services coverage.

Research like this from Morning Consult finds widespread support for the mandate and notes that many Americans would skip lifesaving preventive care if not covered by their insurance in full.

United States of Care highlights what could be lost if the mandate were to be overturned at the federal level here.

The preventive testing coverage mandate facilitates success in accountable care

We know fee-for-service payment leads to misaligned incentives and has created barriers to providing the best longitudinal care, including early disease detection, counseling on risks, and much more. Therefore, standardized requirements for payers to cover services (at no cost to the beneficiary) that we (as a country and with our culture around health sick care) are less likely to pay even a small copay for, are very important.

Value-based care has a number of levers to achieve success, including higher quality care, better outcomes, lower total cost of care, and a better patient experience. One broad lever type is early detection and treatment of diseases, and another is improved patient engagement in self-managing their health and disease burdens. Both fall under the category of “preventive care.”

Preventive services provide a backbone of support for long-term success in improving the health of a population

Here’s what I’m asking myself now: Should the religious views of an employer influence which services they will or won’t be required to cover for their employees who may not share their religious beliefs, even against the recommendations of evidence-based practice?

What’s next?

The Appeals Court reiterated that their role is one of review, and punted back to the lower court to review the services covered under HRSA and ACIP (see definitions in the graphic above).

Next we wait to see what the lower court finds as they respond to the Appeals Court, and if this eventually leads to the Supreme Court taking on the case. For now, the preventive services federal mandate stands.

I’ve received suggestions from new subscribers about topics to cover in newsletter articles. I’ll cover as many as I can.

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A few upcoming newsletter topics:

• Career growth opportunities and new roles for registered nurses in the adoption of advanced primary care

• A guest post by a PharmD sharing pharmacists’ evolving role and untapped value in healthcare delivery innovation

That’s it for today! Thanks for being a reader, and please consider sharing the newsletter with others who might find it helpful!

All the best,

Dana