People deserve preventive care proven to lengthen and improve lives, USPSTF chairman says

A court ruling on part of the Affordable Care Act (ACA) could have potential widespread effects on preventive care around the nation.

Michael J. Barry, MD
_{U.S. Preventive Services Task Force}

But it won’t change the focus of the U.S. Preventive Services Task Force (USPSTF), an independent panel that recommends clinical preventive services for primary care physicians, said Task Force Chairman Michael J. Barry, MD.

On March 30, a Texas judge ruled in favor of a challenge to the Affordable Care Act, meaning health insurance plans no longer are required to cover costs of some preventive care screenings provided to patients for free. The ruling affects the tests recommended by the USPSTF, which the judge said was not appointed properly under federal law because the independent Task Force is not part of the U.S. Department of Health and Human Services.

As news of the Texas court ruling spread, Barry shared this statement with Medical Economics.

“The U.S. Preventive Services Task Force is deeply committed to improving the health of people nationwide by making evidence-based recommendations that help clinicians and patients decide together which preventive services are right for them, and our mission has not changed since we began doing this work nearly 40 years ago.

“Since the Task Force was initially created in 1984, we have based our recommendations solely on the evidence, rather than on any insurance-related considerations. For each of our recommendations, we review the results of well-designed research studies to determine whether use of a specific preventive service such as screening for lung cancer is likely to improve the length and quality of a person’s life without causing undue harm.

“From helping people find cancers early to preventing kids from starting to smoke, we believe that clinicians and patients have a right to know what the evidence shows about how best to stay healthy. In recent years, we have seen the impact of this work, especially on those most in need of health care. Millions of people across the country rely on these services every day to help them get and stay healthy. And as care has become more accessible over the past decade, more people who have low incomes have been able to access the care they need, such as screening for both colorectal and cervical cancer.

“Fundamentally, people across the country deserve the opportunity to receive these important preventive services that have been proven to help them live longer and healthier lives.”

Barry, a primary care physician, took the USPSTF helm on March 15. He is director of the Informed Medical Decisions Program in the Health Decision Sciences Center at Massachusetts General Hospital and a professor of medicine at Harvard Medical School.

Who is affected?

Although the estimates vary, analysts have agreed the preventive services mandated to be free under the ACA have affected millions of Americans, although not everyone uses every service.

Despite the court ruling, “there will be no immediate disruption in care or coverage,” said Matt Eyles, president and CEO of the trade group America’s Health Insurance Plans.

Some insurers may continue offering preventive screenings without cost to patients, to avoid employers upsetting employees who use job-provided health insurance. At least some of the preventive care without copayments “is relatively inexpensive,” according to a Kaiser Health News report.

But having an out-of-pocket cost could stifle preventive services for at least some patients. A Morning Consult study found 40% of respondents were not willing to pay out of pocket for 11 of 12 preventive services provided by ACA.

Based on 2018 figures, six in 10 people with private insurance, or 60%, received some ACA preventive care. That tallies to an estimated 100 million people, according to Peterson-KFF Health System Tracker, a joint effort to analyze health care data across the United States.

As the health care and health insurance sectors have changed in the last decade, an estimated 137 million children and adults with private insurance had access to preventive services without cost, as of 2015. Five years later, that figure grew to an estimated 151.6 million people, due partly to growth in the number of people enrolled in private health coverage and to a decrease in people enrolled in “grandfathered” plans in effect before the ACA. The figures come from a January 2022 issue brief from the Assistant Secretary for Planning and Evaluation Office of Health Policy in the U.S. Department of Health and Human Services.

In a 10-year retrospective published in 2020, the American Cancer Society said “the full picture of how the ACA affects cancer is still emerging,” not least because different parts of ACA took effect at different times, so it was difficult to make a full evaluation of the law.

“Some studies showed an increase in colorectal cancer screening, mammography, and Pap tests — but others showed little or no change,” Stacy Fedewa, PhD, an ACS senior principal scientist, said at the time.