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The healthcare industry is in limbo following a Texas court’s decision to dissolve the Affordable Care Act’s provision that requires no-cost access to some preventive medical care.
Health plans nationwide are no longer required to fully cover a handful of services, including screenings for diseases such as cancer and HIV and other offerings recommended by the U.S. Preventive Services Task Force, after a ruling Thursday by Judge Reed O’Connor of the U.S. District Court for the Northern District of Texas. The White House is expected to appeal the ruling, and industry watchers say the decision could be the start of a lengthy legal battle.
Insurers don’t have immediate plans to head back to the drawing board, but if the ruling stands, it could influence contracts going forward.
Elevance Health, Kaiser Permanente and Blue Cross Blue Shield of Massachusetts said they will continue covering preventive benefits under the terms of their current contracts. The latter two also expressed their concern with the ruling and its potential impact on preventative care for consumers.
“We know these effective interventions prevent disease and save lives,” Kaiser Permanente said in a statement following the ruling. “As we’ve seen most recently during the pandemic, millions of Americans facing economic uncertainty have been able to count on the ACA for coverage, regardless of their health status or preexisting conditions.”
UnitedHealth Group and Blue Cross Blue Shield of Michigan declined to comment on court’s decision. Centene, Cigna, Humana and Florida Blue did not respond to requests for comment.
Coverage of preventive services could be in jeopardy as health plans ink future contracts, said University of Houston Law Center Professor Seth Chandler. Insurers could opt to charge a copay for a preventative service or could fully cover only select services.
“What Judge O’Connor’s ruling would do, if it stands, is open up preventative services to the same kind of negotiations that other medical services are open to,” Chandler said.
The inconsistencies could pose challenges for patients as they mull whether to get screenings for cancer, diabetes and HIV or medications like statins, immunizations and PrEP.
“We are deeply concerned that this decision will create consumer confusion about the coverage and cost of important preventive services,” Blue Cross Blue Shield of Massachusetts said in a statement.
Some providers noted the ruling would particularly affect the nation’s more vulnerable populations.
“There’s a lot we don’t know about the impact of this ruling,” Carolyn Witte, CEO at women’s healthcare provider Tia, said in a statement. “However, women are already facing a ‘triple threat’ to their health in this country – a growing primary care shortage, mental health epidemic and reproductive health crisis. This ruling makes the triple threat even worse, at a time when the stakes for women’s health have never been higher.”
Dr. Viral Patel, CEO of primary and mental healthcare provider Radish Health, said the lack of coverage could deter patients on individual plans from seeking preventive care long-term, contributing to worse health outcomes and an overall higher cost of care. Blood-testing and procedures like colonoscopies are common ways to identify serious diseases earlier, he noted.
“It’ll be interesting to see how insurance companies are trying to push toward value-based care because obviously they’re trying to save to their bottom line,” Patel said. “Self-insured employers are trying to do the same. … Is it saving money in the health plan today versus outcomes later?”
He said he thinks employer-based health plans will be more likely to see the cost-savings benefits of continuing to cover services.
Primary care provider Oak Street Health declined to comment on Thursday’s ruling. VillageMD, One Medical and Carbon Health, which also offer primary care, did not respond to requests for more information.
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