AMA Defends Affordable Care Act’s Preventive Care Coverage Requirement

The American Medical Association (AMA) defended the Affordable Care Act’s preventive care coverage requirement in an amicus brief in the case of Braidwood Management Inc, et al v Becerra.

The amici curiae whose stance this brief represented included not only the American Medical Association but also the American Academy of Family Physicians, the National Medical Association, and other interested parties.

“The research is clear: no-cost preventive care saves lives, saves money, improves health outcomes, and enables healthier lifestyles,” the brief stated.

“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.  By expanding access to insurance coverage, and by requiring insurance plans to cover preventive health services without cost-sharing, such as copays and deductibles, the Affordable Care Act greatly expanded the availability of these services.”

The Affordable Care Act leaned on recommendations from the US Preventive Services Task Force, the physician organizations pointed out. The US Preventive Services Task Force recommendations are seminal for the healthcare industry, particularly in the health insurance space.

“Although the Court has concluded that certain aspects of this structure are unlawful, that fact does not in itself necessitate a remedy that renders the ACA’s preventive-care requirements unenforceable, and thereby imperils access to preventive care, nationwide,” the brief argued.

“We urge the Court to tailor the terms and scope of any remedy it orders to the limited extent necessary to redress the Plaintiff Braidwood Management’s injuries.”

In the Braidwood Management Inc, et al v Becerra case, AMA offered three arguments to persuade the courts to pursue a remedy that was limited to resolving the case at hand instead of challenging coverage for preventive services nationwide.

First, it pointed to the benefits of bolstering preventive care services utilization, both for patient outcomes and for the healthcare system overall.

The Affordable Care Act’s preventive care requirement improved utilization rates for preventive care services, according to an Urban Institute brief. Since the Affordable Care Act passed, screenings for colorectal cancer, cholesterol levels, and blood pressure increased along with vaccinations for viruses like HPV and the flu. Contraceptive utilization rose and PrEP medication was more accessible.

Requiring preventive care services coverage also can help avoid higher costs later on in a patient’s health journey, the AMA brief stated. While preventive care is not a guarantee against high costs, high-cost conditions are easier and less costly to treat in the early stages than in the later stages, thus preventive care services that identify these diseases early can help manage a patient’s healthcare spending.

Second, the Affordable Care Act’s preventive care services coverage requirement improved access to preventive care. Without coverage, it becomes more challenging to convince patients to take preventative measures for their long-term health.

The brief pointed out that as many as 76 million Americans got access to zero cost-sharing preventive care services due to the Affordable Care Act, according to the Office of the Assistant Secretary for Planning and Evaluation (ASPE) of the U.S. Department of Health and Human Services (HHS). A total of around 223 million Americans have access to zero cost-sharing preventive care because of the Affordable Care Act’s requirement.

If the preventive care requirement was rolled back, it could reverse major advances in health equity that have occurred as a result of the requirement.

Lastly, if the Court strips the Affordable Care Act’s ability to enforce the preventive care services requirement nationwide, millions of Americans could experience barriers in access to preventive care services.

The plaintiffs—Braidwood Management Inc, et al—want the Court to prevent coverage mandates nationwide, AMA said.

“The effect of these remedies would be to revert to the pre-ACA regulatory regime, where insurers could charge their enrollees—amici’s patients—for mammograms, colonoscopies, and other services at will,” AMA argued.

“If the Court were to vacate and/or enjoin the Task Force’s recommendations and any efforts to implement them on a nationwide basis, preventive care would be in grave jeopardy for tens of millions of Americans.”

Before the Affordable Care Act went into effect, four in ten employees were in plans that expanded preventive care services coverage to comply with the new law, the brief noted. This indicates the potential impact of rolling back the mandate.

“If this Court invalidates the Task Force’s recommendations nationwide, physicians and healthcare professionals will be left in an untenable situation,” the brief concluded. “The past ten years have shown the benefits of no-cost preventive coverage, and amici ask that the Court hesitate before ordering a remedy that could upset that substantial progress.”