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Court challenge to preventive services: Who is affected?


Peterson-KFF ponders repercussions if patients have to pay out of pocket for vaccines or exams.

Women, children, and older adults could be the patients most affected if legal challenges lead to cuts in preventive health care.

A Peterson-KFF Health System Tracker study analyzed the use of preventive care now free and required under the Affordable Care Act (ACA). Based on 2018 figures, six in 10 people with private insurance, or 60%, received some ACA preventive care.

That amounts to about 100 million people, based on the number of nonelderly people with private health insurance, as tallied by the American Community Survey of the U.S. Census Bureau.

But changes to the law requiring preventive care could lead to greater out-of-pocket costs for exams – and possibly fewer people receiving them, according to the Peterson-KFF study, “Preventive services use among people with private insurance coverage,” published March 20.

The Peterson-KFF study examined effects on preventive services recommended by the U.S. Preventive Services Task Force (USPSTF), the Advisory Committee on Immunization Practices (ACIP), and the Health Resources and Services Administration (HRSA) and its Women’s Preventive Services Initiative (WPSI).

ACA requires private health insurance companies to cover costs of those services. But a court challenge in Texas led to a ruling that could have wider implications for the preventive services, according to the Peterson-KFF study.

“Overturning any part of the ACA’s preventive services coverage requirement would leave coverage decisions to health plans,” the Peterson-KFF report said. “If not for the ACA’s preventive services coverage mandate, health plans would have discretion to apply cost-sharing for these services, which could include copayments, coinsurance, or deductibles.”

Costs vary widely, ranging from about $50 for a flu vaccine to more than $1,000 for a colonscopy, according to Peterson-KFF. Those costs could make some patients delay care, or skip it entirely, which in turn could lead to later diagnoses of health conditions that might have had better outcomes if detected earlier.

Meanwhile, another report estimated two in five adults said they would not pay out of pocket for 11 of 12 preventive services provided by ACA.

Industry observers are waiting on the final ruling expected soon in the court case, known as “Braidwood Management vs. Becerra.” The initial ruling dealt with the requirement to cover pre-exposure prophylaxis (PrEP) to prevent HIV, but it was unclear if a final ruling will apply to other preventive services.

The researchers used 2018 data because the COVID-19 pandemic changed how people accessed preventive care. Studies in 2020 documented decreases in use of routine care such as cancer screenings, because patients had concerns about COVID-19, while in 2021, many adults received COVID-19 vaccines, which count as ACA preventive care.

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