No-Cost Coverage for Preventive Care Uncertain

Recent court ruling casts a spell of uncertainty.

Texas courts have proven to be a common battleground for several federal healthcare initiatives lately- and the latest was a blow to one of the most popular parts of the Patient Protection and Affordable Card Act (PPACA)-a provision ensuring no-cost coverage of certain preventive care services. 

A US District Judge decreed that the PPACA’s requirement of these free preventive care services is unconstitutional, and further agreed with arguments that requiring coverage of HIV prevention treatment PrEP violates rights under the Religious Freedom Restoration Act.  But what does this decision actually affect, and what does it mean for insurers, providers, and consumers going forward?

The provision of the PPACA at issue dictates categories of preventive care that most health insurers are required to cover.  Of the three agencies empowered to determine what kinds of preventive care falls within this provision, only one is largely at issue here: the US Preventive Services Task Force (PSTF). 

The lead plaintiff in this case argued that the way the PSTF is structured violates the US Constitution because its members are a volunteer panel of experts, not appointed by anyone or confirmed by the Senate.  Of concern were the services recommended by the PSTF since the PPACA went into effect: for example, lung and skin cancer screening and perinatal depression interventions. 

Additionally, other plaintiffs felt that the PPACA’s required coverage of PrEP violates their religious beliefs and did not want to be forced to purchase insurance that covers it. The Texas judge agreed with the plaintiffs on both counts, leaving unanswered questions about the future of preventive care.

A recent study found that more than half of adults polled would be unwilling to pay for many preventive services if they were no longer covered by insurance.  This included 38 percent saying they would not even be willing to pay for cancer screenings.  A quarter of the same consumers believed that preventive care is one of the most important services a health plan can offer. In a time where household dollars are already stretched thin, preventive care may be lower on a list of priorities if it is no longer free-a similar study found that over half of consumers surveyed indicated they have avoided medical care due to cost.

Although the decision technically applies nationwide and takes effect immediately, experts note that there are several factors delaying any changes by insurers. 

First, many believe the administration is extremely likely to appeal the decision and ask for a stay in the meantime.

Second, most insurance contracts are in place for the calendar year-meaning changes likely wouldn’t be seen until the next calendar year. And third, insurers are typically required to give advance notice of changes in benefits so consumers would be able to plan their care.

Additionally, several major insurance companies and insurance trade groups have already pledged to continue to provide full coverage for preventive health services regardless of any ruling.  But some believe this might change in the years ahead if the ruling stands, as costs increase, and budgets need to be tightened.

While experts and insurers alike have been quick to advise consumers who currently have preventive care services scheduled to keep their appointment, beyond that the future of preventive care is murky at best.  

But for now, all we can do is wait and keep our eyes on Texas.