Whether insurance companies will be required to continue covering the full cost of preventive health services—a policy credited with saving more than 100,000 lives a year—is in the hands of the U.S. Supreme Court.
The nation’s highest court will decide whether it will overturn a 5th U.S. Circuit Court of Appeals ruling in Braidwood Management v. Becerra (PDF) that jeopardizes an Affordable Care Act (ACA) provision requiring most insurers to fully cover services recommended by the U.S. Preventive Services Task Force (USPSTF). The appeals court sided with plaintiffs who said the president must nominate task force members and the Senate then must confirm those members, a procedure that had not previously happened.
While the case was initiated by a plaintiff challenging the inclusion of pre-exposure prophylaxis (PrEP) for HIV as a preventive essential health benefit under the ACA, the lawsuit threatens coverage for all services the USPSTF recommends.
In an amicus brief that was filed by the Litigation Center of the American Medical Association and State Medical Societies in the Supreme Court with more than two dozen other physician, patient and health care groups, the organizations told the court “the ACA’s preventative care mandate has saved lives and should continue to do so.” The brief lays out hard data on how the requirement saves American lives—and dollars.
The brief further urges the Supreme Court to reverse the 5th Circuit’s decision and rule that provisions relating to the USPSTF’s recommendations are constitutional. So ruling would enable patients to continue accessing—without out-of-pocket costs to them—screenings for breast cancer, colon cancer and other diseases, and also take advantage of other preventive services such as smoking cessation.
“The ACA’s provisions regarding preventative care recommended by the task force are crucial for maintaining strong public health, preventing the development of a wide range of conditions, promoting early detection of certain conditions and improving survival rates,” the brief tells the court in the litigation, now named Kennedy v. Braidwood Management after the administration change. “Impeding patients’ access to preventive care would have an immediate and devastating impact on health outcomes.”
The Supreme court will hear oral arguments in the case on April 21. The AMA Litigation Center has filed amicus briefs in Braidwood Management v. Becerra as the case has wound its way through the court system. For the most recent brief filed in the U.S. Supreme Court, the AMA Litigation Center teamed up with the American Cancer Society, American Academy of Family Physicians, American College of Obstetricians and Gynecologists, National Medical Association, National Hispanic Medical Association, American Medical Women’s Association, American Cancer Society, American Kidney Fund and others.
Find out more about the cases in which the AMA Litigation Center is providing assistance and learn about the Litigation Center’s case-selection criteria.
Upholding decision hurts patients
Researchers have looked at what the impact could be if the appeals court decision is allowed to stand and determined that patients will suffer and health care costs will go up, the brief explains.
One study published last fall examines how the lower-court ruling would affect colorectal cancer incidence, mortality and care costs. Researchers examined the impact of requiring adults to pay for part of the colorectal screening costs among adults 45–49 years old and for polyp removal during diagnostic colonoscopy across all ages.
Researchers found that there would be decreased screening because patients would face out-of-pocket costs. That would, in turn, lead to an additional colorectal cancer diagnosis for seven out of every 100,000 people and an additional four deaths per every 100,000 people annually by 2055. Further, the study found that costs for colorectal cancer would also substantially rise because of increases in diagnoses, overall, and in later stages.
The brief notes other research finding that millions of commercially insured patients would lose access to no-cost cancer screenings if the lower-court decision were allowed to stand. Researchers determined that these are the people who risk losing no-cost coverage:
- 9 million people now getting screened for breast cancer; another 5 million who are eligible for it.
- 3 million now screened for colorectal cancer; 11 million more eligible.
- 500,000 now screened for lung cancer; 2.5 million more eligible.
Screenings save lives
A 2007 study from the National Commission on Prevention Priorities estimated that increasing the number of people who used five preventive services—including several that USPSTF recommends—would save more than 100,000 lives annually in the United States. Findings have been similar for conditions that were not part of that study, says the brief.
“The court of appeals’ decision threatens to erect formidable financial barriers to these lifesaving services and reverse over a decade’s worth of progress in improving health outcomes,” the brief says, adding that physicians would likely “see many of their patients ... turn down medically indicated services because of the very financial barriers that Congress sought to remove.”
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