Appeals court stays ruling on no-cost preventive care under ACA

Tanya Albert Henry , Contributing News Writer

A federal appellate court in New Orleans has ordered an administrative stay on a lower-court ruling that would have stripped patients of the right to access some preventive care services with no out-of-pocket costs, a key piece of the Affordable Care Act (ACA).

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The Litigation Center of the American Medical Association and State Medical Societies and other physician organizations supported the request for stay that came from the Department of Health and Human Services (HHS). They asked the court to partially stay the lower court’s decision “and protect millions of American from losing access to vital preventive services” that they gained a decade ago under the ACA.

The administrative stay leaves patient access to no-cost preventive care under the ACA in place temporarily while the case proceeds, though the court could revisit the issue as the case proceeds.

“No-cost preventive care saves lives, saves money, improves health outcomes and enables healthier lifestyles. Ensuring that patients can receive these services is of the utmost importance to public health. The district court’s unprecedented decision imperils access to these services nationwide,” physicians told the 5th U.S. Circuit Court of Appeals in an amicus brief they filed in the case, Braidwood Management Inc et al. v. Becerra et al (PDF).

In addition to the AMA Litigation Center, the American College of Obstetricians and Gynecologists, American Academy of Pediatrics, American Academy of Family Physicians, American Medical Women’s Association, National Medical Association and about a half dozen other physician organizations signed on to the brief.

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In urging the court to let the government continue enforcing the part of the ACA that requires insurers to cover certain preventive care services, the brief explained that access unimpeded by costs prolongs people’s lives and reduces costs in the health system by catching conditions before they require costly, more invasive care.

“Imposing cost-sharing requirements could deter at-risk patients—and in particular, those of limited means—from scheduling services like mammograms, colonoscopies, and screening tests for osteoporosis, hypertension, diabetes, lung cancer and other conditions that could shorten their lives if undetected and untreated,” the brief said.

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Earlier this spring, the U.S. District Court for the Northern District of Texas Fort Worth Division ruled in the Braidwood case that certain U.S. Preventive Services Task Force recommendations that outline preventive services that insurers must cover under the ACA are unlawful. The judge also said the government cannot take action against insurers for not covering those preventive services.

The ruling, if ultimately upheld, would not just affect those involved in the lawsuit or those in Texas. Rather, it would eliminate no-cost preventive care requirements for patients nationwide. The next step will come June 6, when oral arguments will be heard by the 5th U.S. Circuit Court of Appeals.

As of 2020, about 233 million people were enrolled in plans that must cover preventive services without cost-sharing. The physicians’ brief explained just how important that is, noting research showing 60% of privately insured Americans got ACA preventive care in 2018—about 100 million people.

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The ACA’s preventive care provisions must be maintained

The ruling, physicians said, also threatens to create confusion in the health care insurance market as plans change what they do and do not cover.

Patients would, “for the first time in 10 years, have to scrutinize insurance plans to determine what preventive services they cover, and at what out-of-pocket cost. And they will have to do so both when deciding which plan to select during enrollment, and then again when deciding whether to obtain a particular service. Many will instead decide to forgo basic preventive services entirely,” the brief said.