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Physician Groups Defend Affordable Care Act's No-Cost Preventive Services

Analysis  |  By Christopher Cheney  
   December 02, 2022

About 233 million Americans are enrolled in health plans that cover preventive services without cost-sharing because of the Affordable Care Act.

The American Medical Association (AMA) and seven other physician groups have filed a friend-of-the-court brief defending no-cost access to preventive services under the Affordable Care Act (ACA).

The ACA, which Congress passed in 2010, requires insurers to cover preventive services without cost sharing such as deductibles for services that have "A" or 'B" ratings from the United States Preventive Services Task Force. "A" or "B" ratings indicate that a preventive service has moderate to substantial net benefits, with moderate to high certainty.

On Nov. 30, the friend-of-the-court brief was filed for Braidwood Management v. Xavier Becerra, an ACA case in the U.S. District Court for the Northern District of Texas Fort Worth Division. Braidwood and other plaintiffs in the case want U.S. District Judge Reed O'Connor to rule that insurers can impose cost sharing for preventive services.

The friend-of-the-court brief calls on Judge O'Connor to maintain the ACA's no-cost provision for preventive services. "The Court should refrain from ordering any remedy that would allow insurers to reimpose cost-sharing requirements on the millions of Americans who currently have access to no-cost preventive care. Make no mistake—that is what Plaintiffs seek," the friend-of-the-court brief says.

The physician groups that filed the friend-of-the-court brief with the AMA—known collectively as amici—are the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American Medical Women's Association, the Infectious Diseases Society of America, the National Medical Association, and the Society for Maternal-Fetal Medicine.

The amici say there are several benefits from the ACA's preventive services provision. "The research is clear: no-cost preventive care saves lives, saves money, improves health outcomes, and enables healthier lifestyles. As medical professionals, amici know that preventive care can mean the difference between kicking a smoking habit or living with a heightened risk of dozens of illnesses; between taking a statin or suffering a life-changing heart attack; between providing essential prenatal care and screening or leaving children behind; and between catching a patient's cancer early or catching it after it's too late. Identifying and treating conditions before they worsen, or before they present at all, yields better outcomes for patients and saves money for the health system overall."

Improving health outcomes and bolstering the healthcare system

The AMA and the other amici argue that no-cost preventive services boost public health and the healthcare system. "An extensive body of evidence demonstrates how preventive care can help patients live long, healthy lives. Preventive services include both services aimed at the early detection and treatment of potentially fatal medical conditions and chronic diseases as well as services aimed at encouraging people to adopt healthy lifestyles," the friend-of-the-court brief says.

No-cost preventive services also reduce healthcare costs such as catching cancer in an early phase, the friend-of-the-court brief says. "Put simply, cancer is cheaper to treat at the outset than after it has metastasized."

The ACA has increased utilization of preventive services, the friend-of-the-court brief says. "Prior to the enactment of the Affordable Care Act, the majority of Americans either lacked health insurance or were enrolled in insurance plans that did not cover preventive care without cost-sharing—creating a substantial barrier to widespread use of preventive care."

ACA expanded access to preventive services

The ACA has expanded access to preventive services, the friend-of-the-court brief says. "The ACA's preventive-care requirements have generally been successful in expanding access to preventive care, and for that reason, have proven to be one of the most popular parts of the statute."

Millions of Americans have gained access to preventive services because of the ACA, the friend-of-the-court brief says. "In 2014, the Office of the Assistant Secretary for Planning and Evaluation (ASPE) of the U.S. Department of Health and Human Services estimated that 76 million individuals gained access to preventive care without cost-sharing as a result of the ACA, either by newly enrolling in private insurance or by having already enrolled in insurance plans that shifted to covering preventive care after the ACA's enactment."

The AMA and the other amici say there are now about 233 million Americans who are enrolled in health plans that cover preventive services without cost-sharing because of the ACA.

The ACA is not perfect, but the no-cost preventive services requirement is essential, the friend-of-the-court brief says. "To be sure, the ACA's preventive care requirements are not a panacea; substantial additional work needs to be done to encourage patients to use the means provided to them to obtain these vital services. But gutting the ACA's requirements would impose further barriers, making it even harder for amici to ensure that their patients receive the requisite care."

Related: AMA Calls Eliminating No-Cost Preventive Care 'Unwise and Unthinkable'

Christopher Cheney is the CMO editor at HealthLeaders.


A lawsuit filed in U.S. District Court seeks to overturn the Affordable Care Act's requirement that health plans cover preventive services without cost-sharing.

The American Medical Association and seven other physician groups argue "no-cost preventive care saves lives, saves money, improves health outcomes, and enables healthier lifestyles."

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