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Patients Likely to Skip Preventive Care if ACA Ruling Holds

Analysis  |  By Jay Asser  
   March 17, 2023

A survey finds many will not pay for preventive services if they are no longer covered by health insurers.

Americans won't be quick to reach into their own pockets for preventive care services if courts uphold a ruling that they shouldn't be covered as part of the Affordable Care Act (ACA), according to a survey by Morning Consult.

The business intelligence company polled a sample of 2,199 U.S. adults in January 2023 to gauge the potential ramifications a ruling by a Texas federal judge in September 2022 could have on preventive service utilization.

Judge Reed O'Connor, after previously ruling that the entire ACA was unconstitutional, struck down a key piece of the ACA requiring health insurers to cover 12 preventive services with no cost sharing for members. The ruling on the ACA was ultimately overturned by the Supreme Court, but it could take some time for the recent decision to go through the appeals process and be settled.

If coverage for preventive services are stripped, however, it may result in millions of patients missing out on life-saving care.

The Morning Consult survey found that at least two in five Americans say they are not willing to pay for 11 of the 12 preventive services, with at least half saying they would not pay for services such as tobacco cessation or screenings for HIV, depression, and unhealthy drug use.

Cancer screenings are the preventive service respondents say they would most likely pay out of pocket for, chosen by 46%.

The survey also found that one in three Americans say emergency care is the most important service for insurers to cover. Preventive services were ranked as the most important service for insurers to cover by 23% of respondents, while breastfeeding was chosen as the least important by 35%.

Finally, the survey revealed that half of respondents delayed or skipped care due to cost, with three in 10 saying they did so in the past year. Income was a significant factor, as 32% of respondents living in households making under $50,000 delaying care in the past year, compared to 22% of those who make $100,000 or more.

Adding to patients' healthcare costs by eliminating coverage of preventive services will likely lead to even more patients skipping or delaying necessary care.

American Medical Association Jack Resneck Jr. called the decision by O'Connor "unwise and unthinkable" and strongly stated preventive care requirements must be upheld.

"Providing insurance coverage for drugs that prevent the transmission of infectious disease does not violate anyone’s religious freedom—to the contrary," Resneck said. "This type of preventive care saves lives."

Jay Asser is the contributing editor for strategy at HealthLeaders. 


Morning Consult polled a survey of 2,199 American adults to better understand if preventive service utilization would be affected by a recent court ruling eliminating coverage in the Affordable Care Act.

At least two in five respondents say they are not willing to pay for 11 of the 12 preventive services, with cancer screenings chosen as the service most likely to be paid for.

Half of respondents skipped or delayed medical care because of cost, with three in 10 saying they did so in the past year.

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