Leave ACA’s zero-cost preventive care intact, AMA tells court

Tanya Albert Henry , Contributing News Writer

Editor’s note: The U.S. District Court for the Northern District of Texas Fort Worth Division has issued a ruling that jeopardizes access to preventive health care services that the ACA has guaranteed patients have access to without a cost. The judge ruled that certain U.S. Preventive Services Task Force recommendations that outline preventive services that insurers must cover under the ACA are unlawful.

The judge further ruled that the government cannot take action against insurers for not covering these preventive services. “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,” Dr. Resneck said in a statement. “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.”

A lawsuit in Texas is threatening access to no-cost preventative care services for patients across the entire country—crucial services that millions of Americans gained access to under the Affordable Care Act (ACA).

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The Litigation Center of the American Medical Association and State Medical Societies, along with the American College of Obstetricians and Gynecologists (ACOG), American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP) and four other national associations tell the court that the country can’t go backward.

The U.S. District Court for the Northern District of Texas Fort Worth Division is currently considering a case challenging an ACA provision that for more than a decade has allowed patients to access life-saving mammograms, colonoscopies, mental health screenings, weight-loss programs, smoking-cessation programs and numerous other proven preventive measures without having to worry about out-of-pocket expenses.

If the court orders broad, nationwide relief, the decision would imperil access to vital preventative care that keeps patients healthier and lowers overall costs for the health care system, physicians tell the court in an amicus brief (PDF) they filed in the case, Braidwood Management Inc. et al. v. Becerra et al.

The AMA Litigation Center, ACOG, AAP, AAFP and others tell the court that invalidating the ACA’s preventative care requirement would put physicians and other health care professionals in an untenable situation. They urge the judge to exercise “equitable discretion” in the case.

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The ACA’s preventive care provisions must be maintained

Physicians and others “will struggle to encourage their patients to accept services that they know will save lives and to help their patients navigate a new and confusing insurance situation,” the friend-of-the-court brief says. They also “will see many of their patients, including some of their most vulnerable, turn down medically indicated services because of the very financial barriers that Congress sought to remove. The past ten years have shown the benefits of no-cost preventative coverage and amici ask that the Court hesitate before ordering a remedy that could upset that substantial progress.”

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.

The Braidwood case (PDF) involves six people and two businesses. They are challenging whether the ACA’s preventive care service requirements are legal under the U.S. Constitution and the Religious Freedom Restoration Act (RFRA).

Each plaintiff objects to the mandate based on either religious or economic reasons and wants to get or provide health insurance that excludes or limits coverage that the mandate requires. For example, the lawsuit challenges a requirement related to pre-exposure prophylaxis (PrEP) drugs to prevent HIV transmission, claiming that it violates RFRA.

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“An extensive body of evidence demonstrates how preventative care can help patients live long, healthy lives,” says the brief filed by the AMA and others.

Increasing the use of just five preventive services would save more than 100,000 lives annually in the United States, according to research cited in the brief. And by detecting disease early, health system costs are reduced because less invasive or complex treatment options are needed, the brief says.

Learn more in this AMA Leadership Viewpoints column by AMA President Jack Resneck Jr., MD, about why the ACA’s preventive care provisions must be maintained.

The ACA “significantly expanded access to no-cost preventive care,” the AMA Litigation Center and other amici tell the court. In 2014, the Department of Health and Human Services estimated that 76 million Americans gained access to this care by either newly enrolling in private insurance or having an insurance plan that began covering preventive care after the ACA passed. Today, about 233 million people with private health insurance, Medicare and Medicaid have plans covering preventive services with zero cost-sharing, the brief tells the court.

Read more about how this lawsuit could stop 150 million people from getting free preventive care.