California, Michigan consider legislative action to maintain preventive care coverage requirement

Leaders in California and Michigan are urging lawmakers to take action to codify preventive care coverage after a Texas judge struck down some requirements for payers to cover preventive services at no cost to members under the ACA. 

Michigan Gov. Gretchen Whitmer directed the state's insurance and financial services department to issue guidance about which preventive services are affected by the decision and develop recommendations for actions the state can take to maintain preventive care coverage. 

"In addition, I will be calling on both the state legislature and Congress to take swift action to pass laws to help ensure that Michiganders can continue to have access to these critical services without having to worry about whether they can afford it," Ms. Whitmer said in an April 3 letter.

On March 30, a federal judge in Texas struck down an ACA provision that requires insurance companies to provide coverage for preventive services such as certain cancer screenings and HIV prevention drugs.

On March 31, the Biden administration appealed the ruling in the 5th Circuit Court of Appeals.

In California, Insurance Commissioner Ricardo Lara is co-sponsoring legislation to strengthen the state's existing preventive care coverage requirements for health plans. 

In a March 30 news release, Mr. Lara said health plans regulated by the state must continue covering preventive care at no cost under current California law, but the court ruling may apply to employer-sponsored plans. 

Legislation co-sponsored by Mr. Lara would require plans to cover all preventive care at no cost, including office visits to deliver preventive benefits. 

A separate bill would require all plans, including grandfathered plans not required to follow ACA regulations, to cover HIV prevention drugs with no cost sharing. 

"These bills, combined with existing state law, ensure that Californians are protected against this utterly reprehensible, unreasoned, and partisan decision from the same judge who has tried, and repeatedly failed, to strike down the ACA," Mr. Lara said in the news release. 

Health insurers have indicated they will still cover preventive services for now, though they may raise cost sharing for members for certain services in the future, according to KFF. An increase in costs will not happen immediately because of current contracts, but that could change in the next calendar year. 

"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," AHIP President and CEO Matt Eyles said March 30.

"As sweeping as this ruling is, it does not immediately overturn preventive services," Larry Levitt, executive vice president for health policy at KFF, told reporters March 30. "Previous cases to the ACA have threatened the very existence of the law. This case does not do that. It strikes a certain portion of the law, albeit a very popular one."


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