Family physicians say court ruling on preventive care ‘will jeopardize health outcomes’

Texas case involves ACA provision that physicians say is crucial for millions of Americans.

The American Academy of Family Physicians (AAFP) panned a court ruling that could stifle access to free preventive screenings and medical services for patients.

The Sept. 7 ruling in the case known as Kelley v. Becerra, in the U.S. District Court-Northern District of Texas struck down part of the federal Affordable Care Act (ACA) that requires insurers and employers to cover HIV prevention drugs, according to The Hill. Plaintiffs challenged the ACA mandate that health insurance cover pre-exposure prophylaxis, or PrEP, drugs at no cost, arguing they did not need or want the coverage and that policies violated the Religious Freedom Restoration Act, according to the complaint posted at Bloomberg Law.

The ruling “is concerning,” the Academy’s official Twitter account said. “If this ruling stands, patients face higher costs & restricted access to preventive health care services, like cancer screenings,” the Tweet said.

It included a statement by AAFP President Sterling N. Ransone Jr., MD, FAAFP, who said “family physicians are alarmed by the U.S. District Court’s decision.”

If it stands, “it will jeopardize health outcomes by creating financial barriers to screenings, counseling and preventive medications that improve patients’ health,” Ransone said in the statement. “AAFP calls on lawmakers, insurers and health plan sponsors to ensure patients can continue to access high-value, essential preventive services without cost-sharing.”

For months, physicians and analysts have argued the case could have widespread ramifications for health care services across the country.

This summer, the American Medical Association (AMA) led a joint statement with dozens of physician groups arguing the case’s potential to hurt health care for millions of people. In 2020, an estimated 151.6 million people had private health coverage benefitting from the ACA provisions. AMA cited that figure, which was included in an issue brief by the Office of Health Policy of the U.S. Department of Health and Human Services’ Assistant Secretary for Planning and Evaluation.

“With an adverse ruling, patients would lose access to vital preventive health care services, such as screening for breast cancer, colorectal cancer, cervical cancer, heart disease, diabetes, preeclampsia, and hearing, as well as access to immunizations critical to maintaining a healthy population,” the organizations wrote in the July 26 joint statement. “Our patients cannot afford to lose this critical access to preventive health care services. Rolling back this access would reverse important progress and make it harder for physicians to diagnose and treat diseases and medical conditions that, if caught early, are significantly more manageable.”

The Commonwealth Fund, and the Robert Wood Johnson Foundation and the Urban Institute, published analyses about the effects of the preventive services on patients and the legalities of the federal rules.

If the preventive services rule is overturned, the medical care itself does not necessarily disappear.

But “private health plans will be able to charge cost sharing for these life-saving services,” the Urban Institute report said, and some insurers and health plans “might opt to drop coverage of certain services altogether or to impose cost sharing on care,” according to the Commonwealth Fund.

“These changes would increase out-of-pocket costs for millions of Americans, leading to reduced access to preventive care, worsening long-term health outcomes, and deepening health disparities,” said the Commonwealth Fund report, “The Latest Legal Challenge to the Affordable Care Act’s Preventive Services Guarantee.”

Health insurance cost experts made similar predictions based on the ruling, according to a report by Managed Healthcare Executive.

The studies and news reports noted Judge Reed O’Connor has issued several ACA rulings, including the finding that the entire act was invalid, a decision that the U.S. Supreme Court rejected in 2021.