Hospital groups support preventive health services at stake in court fight

Certain preventive health care services should remain free for patients while a federal appeals court considers a legal challenge to part of the Affordable Care Act (ACA).

The American Hospital Association (AHA), the Federation of American Hospitals, the Catholic Health Association of the United States, America’s Essential Hospitals, and the Association of American Medical Colleges (AAMC) announced their support of the preventive health care as the U.S. Court of Appeals for the 5th Circuit considers a legal challenge to those services.

It’s another step in the court fight over preventive care recommended by the U.S. Preventive Services Task Force (USPSTF) and that health insurers pay for without patient cost sharing as required by the ACA.

In March, a judge in Texas vacated that requirement – but the consequences could be dire, according to the hospital organizations.

“Preventive services requiring coverage without cost-sharing under the ACA benefit patients by enabling early detection, management, and treatment of chronic diseases and acute conditions, which can extend and improve patients’ lives,” the hospital group’s legal brief said. “The ACA’s covered preventive services also benefit the public as a whole by lowering costs for patients, providers, and insurers, leading to more affordable health care for all.”

The U.S. Department of Health and Human Services (HHS) is asking the appeals court to postpone enforcement of the ruling while the case remains pending.

“The Affordable Care Act has saved the lives of millions and provided the security that our families need and depend on,” HHS Secretary Xavier Becerra said in a statement. “Efforts to strip away access to preventive health care are harmful and unacceptable. We are seeking a stay on behalf of the millions of Americans who are able to access crucial, free preventive care like cancer screenings and cholesterol medications to prevent heart disease through the Affordable Care Act.

“President Biden, and this entire Administration, will do everything possible to protect and defend Americans’ right to the health care they need and deserve,” Becerra’s statement said.

Over the last month or so, physician organizations have spoken publicly in favor of the preventive screenings to keep people healthy and avoid more expensive medical care in the future.

Court action

The case is known as Braidwood Management v. Becerra.

In 2020, a Christian-owned Braidwood Management Inc. filed a federal lawsuit in Texas to challenge the preventive services requirements. Braidwood and other plaintiffs argued those services were unconstitutional because USPSTF members are not appointed as required by federal law because the Task Force is not part of the U.S. Department of Health and Human Services.

The ACA required insurers to pay for pre-exposure prophylaxis (PrEP) drugs to prevent the spread of HIV, as recommended by USPSTF. The plaintiffs also argued the requirement violates their religious freedom under the Religious Freedom and Restoration Act, according to a summary published by Harvard Law School’s Center for Health Law and Policy Innovation.

In Texas, Judge Reed O’Connor agreed and threw out the requirements to cover preventive treatments recommended by USPSTF since March 2010. Many of the treatments still are available, but at least one study found at least 2 in 5 adults would not pay for them out of pocket.

“This ruling could affect coverage of a wide range of preventive services across the United States and has the potential to cause widespread uncertainty, accelerate health disparities, and degrade public health efforts,” the Harvard Law School summary said. The screenings and interventions include checks for lung cancer, hepatitis B and C, and colon cancer; tobacco use by children; statins to prevent heart disease; aspirin to prevent preeclampsia; and medications to lower the risk of breast cancer.

A KFF analysis noted the USPSTF members are appointed by the director of the U.S. Agency for Healthcare Research and Quality (AHRQ). But USPSTF recommendations are not subject to AHRQ oversight or approval.

Apart from patient health, KFF and the Harvard Law School analysis noted the case could go to the U.S. Supreme Court. That could lead to judicial action over how Congress delegates authority to federal agencies, possibly limiting federal agency powers, the legal analyses said.