Millions could lose no-cost preventive services if SCOTUS upholds ruling

A recent study conducted by the Stanford Prevention Policy Modeling Lab (PPML) has revealed that approximately 30% of privately insured individuals in the United States, amounting to nearly 40 million people, utilize free preventive health services that are mandated under the Affordable Care Act (ACA).

However, these crucial services are currently facing a legal challenge that could put them in jeopardy.

On April 21, the Supreme Court is set to hear arguments in Kennedy v. Braidwood Management Inc., a case that will determine whether the ACA preventive services mandate, which ensures cost-free coverage for specific preventive services by private insurers, is constitutional.

These preventive services include essential screenings such as blood pressure, diabetes, and cholesterol tests, as well as cancer, HIV, and hepatitis C virus screenings. The legality of mandating services recommended by the U.S. Preventive Services Task Force (USPSTF) is at the center of this case.

Usage of Preventive Services

The PPML team, comprised of researchers from the Stanford School of Medicine and Harvard T. H. Chan School of Public Health, analyzed claims data from privately insured individuals across various states to determine the utilization of the ten most critical preventive services that could be impacted by the Braidwood case.

According to the study published in JAMA Health Forum, almost 30% of privately insured individuals, especially women, rely on at least one of these services at no cost. States like Texas, where the case originated, have over 3 million recipients of these services, highlighting the widespread impact of the potential ruling.

“Preventive services are essential for healthcare. Removing the guaranteed access to these services could lead to decreased utilization of evidence-based screening and treatment interventions, resulting in poorer health outcomes,” stated Dr. Josh Salomon, a professor of health policy at Stanford and senior author of the study.

The Threat to Preventive Services

Prior studies have indicated that around 150 million individuals with employer-sponsored insurance are eligible for the free preventive services mandated under the ACA. The new Stanford-led study offers the most detailed analysis to date on the potential consequences of a ruling in the Braidwood case, particularly focusing on services with revised USPSTF recommendations.

The court will specifically evaluate whether the mandatory coverage of USPSTF-recommended services violates the Constitution’s Appointments Clause, as well as address claims related to religious rights, such as the coverage of HIV prevention medication.

The study examined a cohort of 16.1 million individuals with employee-sponsored health insurance to identify services most likely impacted by the case, including screenings for various cancers and infections. The researchers emphasized the popularity of the ACA preventive services mandate and its significance for millions of insured individuals across the United States.

The outcome of the Braidwood case will have far-reaching implications for the provision of preventive healthcare services to millions of Americans, highlighting the critical role played by the ACA in ensuring access to essential screenings and treatments.