Insurers are stressing there will be no immediate changes in coverage after a Texas judge struck down an ACA provision that requires insurance companies to provide no-cost coverage for preventive services such as certain cancer screenings and HIV prevention drugs.
U.S. District Judge Reed O'Connor ruled March 30 that preventive care recommendations made by the U.S. Preventive Services Task Force do not need to be complied with and blocked the federal government from enforcing its recommendations.
The new ruling only applies to task force recommendations made by the panel on or after March 23, 2010 (when the ACA became law), such as statins; lung and skin cancer screenings; and pre-exposure prophylaxis, or PrEP, an HIV prevention drug. STI screenings and cancer screenings such as mammograms and cervical screenings,would still be included for preventive coverage.
Here's how five healthcare leaders reacted to the decision:
1. AHIP President Matt Eyles said there will be "no immediate disruption in care or coverage" as a result of the decision.
"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," Mr. Eyles said.
2. Jack Resneck Jr., MD, president of the American Medical Association, called the ruling "deeply flawed."
In a statement, Dr. Resneck said the AMA strongly urges employers and insurers to maintain preventive care coverage while the next legal and legislative steps are considered.
"Providing insurance coverage for screenings and interventions that prevent disease saves lives — period. Invalidating this provision jeopardizes tools physicians use every day to improve the health of our patients," Dr. Resneck said.
3. Blue Cross Blue Shield of Massachusetts said coverage for preventive services will not change for its members at this time.
"While we are reviewing the details of the ruling out of Texas and awaiting anticipated further legal action by the federal government, we are deeply concerned that this decision will create consumer confusion about the coverage and cost of important preventive services including screenings for cancer, diabetes, HIV, and depression, as well as preventive medications such as statins, immunizations and PreP," the payer said in a statement.
4. California Insurance Commissioner Ricardo Lara said he will work with state lawmakers to introduce legislation to strengthen preventive care requirements in the state.
In a statement, Mr. Lara said health plans must continue to cover preventive care without cost sharing under California law, but the ruling could affect employer-sponsored plans not regulated by the state.
"Today's ruling is another egregious example of conservative judges legislating discrimination against women, people of color, LGBTQ+, and lower income working Americans who have a hard enough time accessing healthcare and, in many cases, can't afford the expense of lifesaving preventive care," Mr. Lara said.
5. A group of researchers at the Yale School of Public Health in New Haven, Conn., predicted an overturn of no-cost preventive care coverage would lead to an increase of over 2,000 cases of HIV in the United States in the next year.
Meredithe McNamara, MD, assistant professor of pediatrics at Yale School of Medicine, said the ruling will disproportionately affect racial and ethnic socio-demographic groups at high risk for HIV infection.
"The burden of new restrictions on access to PrEP will fall on Black and Latino gay and bisexual men, as well as transgender women, who already face significant barriers to HIV prevention and care," Dr. McNamara said.