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Providers and Insurers React to 'Deeply Flawed' ACA Ruling on Preventive Care

Analysis  |  By Jay Asser  
   March 31, 2023

The new ruling applies to task force recommendations issued on or after the Affordable Care Act (ACA) was signed into law.

The American Medical Association (AMA) expressed concern and disappointment over the recent ACA ruling on preventive care, while AHIP emphasized coverage won't be immediately affected.

U.S. District Judge Reed O'Connor struck down enforcement of preventive care mandates under the ACA, determining that health insurers are not required to cover services such as cancer and heart screenings.

The decision applies to recommendations made by the U.S. Preventive Services Task Force on or after March 23, 2010, when the ACA became a law.

The Biden administration filed a notice of appeal two days after the ruling was made.

AMA president Jack Resneck Jr. said in a statement that the physician association "is alarmed by today’s deeply flawed court ruling in Texas" and decried the decision.

"Providing insurance coverage for screenings and interventions that prevent disease saves lives—period," Resneck said. "Invalidating this provision jeopardizes tools physicians use every day to improve the health of our patients."

Meanwhile, AHIP president Matt Eyles stated that patients will continue to have preventive services covered as the appeal process plays out.

"Every American deserves access to high-quality affordable coverage and health care, including affordable access to preventive care and services that help avoid illnesses and other health problems," Eyles said in a statement. "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."

Loss of coverage for preventive care could have serious consequences, according to a recent survey by Morning Consult.

The business intelligence company polled a sample of 2,199 Americans and found that at least two in five respondents are not willing to pay for 11 of the 12 preventive services. Cancer screenings are the service respondents said they would most likely pay out of pocket for.

If O'Connor's ruling holds up, it could result in patients skipping or delaying necessary care.

Jay Asser is the contributing editor for strategy at HealthLeaders. 

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