Non-Preventative Care: Dismantling the Affordable Care Act and its Coverage of Many Preventative Services
Almost all of us are familiar with the Affordable Care Act (ACA), which is a comprehensive healthcare reform law that was signed into law by President Barack Obama in March 2010. The ACA, also known as Obamacare, has/had the goal of increasing access to affordable health insurance coverage for Americans, particularly those who had previously been uninsured. It included several provisions that aim to achieve this goal, including the creation of health insurance marketplaces where individuals can shop for and purchase insurance plans, and the expansion of Medicaid to cover more low-income individuals. Most importantly, the ACA also includes numerous consumer protections, such as a ban on insurers denying coverage based on pre-existing conditions, a requirement for insurers to cover preventive care services without cost-sharing, and a provision that allows young adults to stay on their parents’ insurance plans until age 26.
However, despite all the good that the ACA has brought, a ruling on Thursday is threatening to dismantle it piece by piece. A federal judge here in Texas has struck down a key provision in the ACA that mandates insurers provide preventive services for free, including those for cancer screenings. “The judge’s decision means millions of people could lose access to over 60 essential preventive services aimed at early detection of diseases, including breast and cervical cancer screenings, as well as breastfeeding support and pregnancy-related preventative care, including screenings for postpartum depression, preeclampsia and gestational diabetes. Research has shown that the ACA cost-free coverage of preventative services led to more people using them and narrowed care disparities in communities of color….This decision allows employers to deny coverage of lifesaving medication, taking health care decisions away from patients.”[i] Despite this ruling happening in Texas, this new mandate will immediately affect everyone nationwide. Most affected by this ruling will be communities of color lacking access to such services.
The free nature of these preventative services made healthcare accessible to these communities and improved their livelihoods, however, by taking this away we are once again seeing the disparities in healthcare. “Across the country, people in some racial and ethnic minority groups experience higher rates of poor health and disease for a range of health conditions, including diabetes, hypertension, obesity, asthma, heart disease, cancer, and preterm birth, when compared to their White counterparts. For example, the average life expectancy among Black or African American people in the United States is four years lower than that of White people.[3] These disparities sometimes persist even when accounting for other demographic and socioeconomic factors, such as age or income.”[ii] By having access to preventative care at no cost we moved closer to health equity where all can achieve the highest level of health despite racial, environmental, financial, etc. factors. “Reimposing cost sharing on these services will significantly reduce patients’ ability to access them, and this burden will disproportionately fall on low-income patients, patients of color, and women and other patients who can become pregnant.”[iii]
It is argued that free preventative care has been a shining mandate of the ACA. “Health policy experts describe free preventive care as one of Obamacare’s most transformative policies because it took away a financial barrier to needed care for tens of millions of Americans. It is also one of the law’s more popular provisions, with 62 percent of the public recently saying it is “very important” that it stay in place…The Texas ruling means that insurers no longer have to provide free coverage for any care the United States Preventive Services Task Force has recommended since 2010. In that time, the federal task force has endorsed at least four new types of preventive care. This includes three new type of screenings: one for anxiety in children, another for unhealthy drug use and a third for weight gain in pregnant women. It also includes a recommendation for PrEP, a daily pill that is highly effective at preventing the transmission of H.I.V….The ruling does not affect all preventive care. Insurers are still required to cover all types of birth control, for example, and all recommended vaccines (including the Covid-19 vaccine) at no cost to patients. They are also still required to cover mammograms, pap smears and other common screenings the task force had recommended before 2010, but they will not have to follow any of its newer guidance on when those tests are appropriate.”[iv] Although the task force has highlighted these areas of preventative care as necessary, with the new ruling these will no longer be covered. Medications such as PrEP, which is vitally important, will now come at out of pocket cost, which will be unattainable for most. Where we were once doing good, with this ruling, the US has once again shown its pitfalls in the realm of healthcare. The ACA moved us forward toward a future where healthcare could one day be accessible to all equitably, but this ruling pushes us farther back than where we started.
However, not all preventative care was taken away. “Insurers are still required to cover all types of birth control, for example, and all recommended vaccines (including the Covid-19 vaccine) at no cost to patients. They are also still required to cover mammograms, pap smears and other common screenings the task force had recommended before 2010, but they will not have to follow any of its newer guidance on when those tests are appropriate.”[v] Although tests will still be covered, any task force recommendations post-2010 will not be covered. A lot has changed since 2010 and advancements have been made, but through this ruling, these cannot be mandated. It is expected that the Biden administration will appeal this decision, but Texas is in the conservative fifth circuit court of appeals. After this, it would go to the supreme court which is also conservative.
Our healthcare system in the US is broken and we are in no rush to fix it. Health equity is something of science fiction to all of us as access to healthcare and the ability to afford it is not easily attained. It seems that when we take one step forward, we then take 5 steps back. Until everyone can get the same level of care at affordable prices we will be forever flawed. Everyone deserves access to healthcare at the same level and this ruling is only pushing us farther from this hoped reality.
[i] Baker, Carrie N. Republican-Appointed Judge Strikes Down Affordable Care Act Coverage of Many Preventative Services: ‘A Huge Blow to Americans’ Health’. Ms. Magazine, https://msmagazine.com/2023/03/31/affordable-care-act-texas-republican-judge/.
[ii] Center for Disease Control and Prevention. What is Health Equity. CDC, https://www.cdc.gov/healthequity/whatis/index.html.