Healthcare insurance programs could be changing after a federal judge in Texas on Thursday ruled that insurance companies don’t have to pay for cancer and heart screenings as well as some other preventive care measures required under the Affordable Care Act. In addition to the effects of the ruling on employers and employees, one senior living organization is concerned that the ruling could affect older adults’ health.
The decision by Judge Reed O’Connor in the Northern District of Texas prevents enforcement nationwide of major portions of the services recommended by the US Preventive Services Task Force.
“Nearly 95% of older Americans have at least one chronic condition, and 80% have two or more,” Maggie Elehwany, senior vice president of public affairs for Argentum, told the McKnight’s Business Daily. “Each day, assisted living communities help manage the chronic diseases of residents, and by supporting social determinants of health (adequate nutrition, housing, healthcare, etc.) help keep seniors healthier and reduce the costs of care. We are concerned that financial barriers that could preclude seniors from receiving key preventative care could translate into worse health outcomes for seniors and much higher costs in the long run.”
Insurance coverage contracts generally run through the end of the year, so it is unlikely that Reed’s ruling will have any practical effect before 2024, if ever. Experts expect the Biden administration to appeal Reed’s ruling and ask for a stay. If the appeals court denies the stay, however, the case could end up before the Supreme Court.
But the case has the potential to do away with a benefit that many Americans have come to expect.
“100 million people use preventive services required by the ACA in a typical year,” Kaiser Family Foundation Executive Vice President for Health Policy Larry Levitt said during a Thursday afternoon online panel discussion. “The ACA’s preventive services requirement is the provision that affects the broadest number of people, and it has been enormously popular with the public.”
Right now, Levitt said, insurance plans must cover preventive services and cannot impose deductibles or copays for them.
Over time, he added, “millions of people could end up paying more for prevention if this ruling stands. This is not the potential fatal blow to the ACA, like previous court cases, but it would limit a very popular benefit that tens of millions of people use.”
The ruling applies only to updates or new preventive care recommendations made since March 2010, when the ACA was enacted, but it would affect preventive care such as statins to prevent heart disease, lung cancer screenings, skin cancer screenings and HIV pre-exposure prophylaxis, or PrEP, pills. It’s unlikely that insurers will stop covering such services altogether, but enrollees might have to kick in a share of the cost. Preventive services could be costly for patients if cost-sharing becomes the norm.
“Our patients cannot afford to lose this critical access to preventive healthcare services. Rolling back this access would reverse important progress and make it harder for physicians to diagnose and treat diseases and medical conditions that, if caught early, are significantly more manageable,” the American Medical Association, along with the American Geriatrics Society and dozens of other medical industry organizations, wrote in a joint statement last summer about the case, Kelley v. Becerra.
