Physicians slam court ruling against ACA requirements for free preventive care

Americans’ health will suffer due to a court ruling that strikes down free preventive services in the Affordable Care Act (ACA), according to physician groups.

Doctors, other clinicians, politicians, and health care industry observers were reacting to the March 30 judgment in a legal fight over recommended preventive services that the ACA requires insurance companies to pay for.

In Texas, U.S. District Judge Reed O’Connor ruled in favor of plaintiffs who challenged the ACA requirement by claiming that providing preexposure prophylaxis (PrEP) drugs against HIV, violated their rights under the Religious Freedom Restoration Act.

The plaintiffs also contested the mandate for preventive services recommended by the U.S. Preventive Services Task Force (USPSTF). The plaintiffs argued, and the court agreed, USPSTF’s voluntary members were not appointed as required by federal law because the task force is not part of the U.S. Department of Health and Human Services (HHS).

The medical services still would be available for patients to pay for, but a recent survey found adult patients likely would not pay out of pocket, regardless of cost.

Physicians speak out

Leaders of the American Academy of Family Physicians (AAFP), the American College of Physicians (ACP), and the American Medical Association (AMA) all issued statements slamming the court order.

They noted ruling affects not only PrEP drugs against HIV, but preventive care for maladies ranging from cancer to heart disease to obesity to childhood lead poisoning.

“Preventive care, which family physicians routinely provide, is necessary to keep our nation healthy and reduce health care expenditures,” AAFP President Tochi Iroku-Malize, MD, FAAFP, said in a statement. “Research demonstrates that health care systems that prioritize access to primary and preventive care improve patient outcomes and lower health care costs, including decreases in costly hospitalizations and emergency department visits.”

She noted the court ruling upheld the contraceptive coverage mandate and coverage requirements for immunizations and preventive services recommended by the Advisory Committee on Immunization Practices and the Health Resources and Services Administration. Those two board also recommend covered preventive services, along with USPSTF.

“The AAFP urgently calls on lawmakers, insurers, and health plan sponsors to ensure that patients can continue to access high-value, essential preventive services without cost-sharing,” Iroku-Malize said.

ACP reacts

The preventive measures “have proven extremely popular,” with one analysis estimating 100 million people with private insurance received covered services in 2018, said ACP President Ryan D. Mire, MD, MACP.

“Patients need access to health insurance, but more importantly, they need access to health insurance that actually covers the preventive services that keep them healthy,” Mire said in his statement. “Subjecting patients to increased costs, or potentially doing away with coverage altogether for important preventive services means many of my patients may no longer be able to access the care they need which will result in worse health outcomes for countless Americans. The U.S. repeatedly ranks last in health outcomes compared to other industrialized countries; this ruling will only further widen that gap rather than focus on efforts to close it.”

ACP called for the decision to be reversed before patients lose access to the preventive services. With federal subsidies to cover costs, ACA insurance plans have record enrollment over the last year, Mire said. “We should be looking for other ways to work toward universal coverage, rather than stripping away care from patients,” he said.

AMA favors prevention

AMA President Jack Resneck Jr., MD, called the ruling “deeply flawed.” Services for maladies ranging from cancer to hypertension, diabetes, cholesterol, and childhood lead poising “could just go away,” Resneck’s statement said.

“Providing insurance coverage for screenings and interventions that prevent disease saves lives – period,” Resneck said. “Invalidating this provision jeopardizes tools physicians use every day to improve the health of our patients.

“And the burden of losing this first-dollar coverage will fall disproportionately on low-income and historically marginalized communities that are least able to afford it and are often at high risk of developing preventable medical conditions,” Resneck said. “Denying access to proven preventive care flies in the face of good policy, and the societal costs of establishing barriers to preventive services are immeasurable. Physicians know the inevitable result when courts interfere with insurance coverage of effective, proven interventions. Patients will be subjected to needless illness and preventable deaths. We strongly urge employers and insurers to maintain this first dollar coverage while legislative and judicial next steps are considered.”

No disruptions in service

With the new ruling and a possible appeal, it was unclear exactly what would happen in examination rooms and insurance companies across the nation.

Patients should not expect disruptions in care or coverage, said Matt Eyles, president and CEO of America’s Health Insurance Plans (AHIP) trade group.

“Every American deserves access to high-quality affordable coverage and health care, including affordable access to preventive care and services that help avoid illnesses and other health problems,” Eyles said in a statement. “As we review the decision and its potential impact with regard to the preventive services recommended by the United States Preventive Services Task Force, we want to be clear: Americans should have peace of mind there will be no immediate disruption in care or coverage.

“We fully expect that this matter will continue on appeal, and we await the federal government’s next steps in the litigation, as well as any guidance from relevant federal agencies.”

Politicians take aim

At least two lawmakers noted political implications of the ruling, claiming Republican leaders still are aiming to take down the ACA, which is known as Obamacare for former President Barack Obama.

Rep. Frank Pallone (D-New Jersey), the ranking member of the House Energy & Commerce Committee, said the U.S. the Department of Justice immediately should appeal the “reckless” decision and ask for a court-ordered stay so that Americans do not lose access to care.

“I am also calling on all health care insurers to commit to continuing to cover all preventive services without cost-sharing while this case is litigated and until final disposition of the lawsuit,” Pallone said in a statement. “There is no excuse to eliminate consumer protections because of a meritless decision that I expect will rightfully be overturned on appeal. I will be following up with insurers for their commitments in writing.

“Finally, it’s incomprehensible that more than a decade after the ACA was signed into law, a rogue judge in Texas is still attempting to usurp clear congressional intent and undermine consumer protections,” Pallone’s statement said. “The ACA is here to stay and Democrats will stand united against Republicans’ ongoing efforts to take away Americans’ health care.”

Rep. Suzan DelBene (D-Washington) said the “decision leverages extreme MAGA ideology to rip health care away from millions of Americans across the country.”

“Preventive screenings save money in the long run by catching diseases and conditions when they are more manageable and treatable,” DelBene said in a statement. “I am extremely concerned that this decision also paves the way to strike down access to contraception. Republicans and activist conservative judges will stop at nothing to undermine the Affordable Care Act and reproductive health care.”

Legislative solution?

Based on the judge’s decision about USPSTF recommendations, changing the legal language of ACA could be as simple as stating that the voluntary USPSTF serves in an advisory role to make recommendations that HHS approves for free coverage, said Laurie Sobel, KFF associate director for women's health policy.

That would not require a lot of words, “but it potentially requires very difficult politics,” because ACA remains a lightning rod for a divided Congress with a presidential election looming in 2024, said Larry Levitt, KFF executive vice president for health policy. Levitt, Sobel, and other KFF analysts convened online to speak about the court ruling with news media on March 30.