Judge Strikes Down ACA's Required Coverage Of Preventive Care

[RobbieB]

Yeah, I was a low risk and just had my first colonoscopy at age 67. Blood detected in annual stool test. Six polyps removed, next in 3 years.

 

[yakers]

I read a study many years back that said it was cost effective to the medical system to smoke, despite the various treatment costs the person died years earlier so total costs were less.

 

[harley]

Yeah, I was a low risk and just had my first colonoscopy at age 67. Blood detected in annual stool test. Six polyps removed, next in 3 years.

Got my first one scheduled for next week. Also 67. Got a positive Cologuard test. Hoping it was a false positive, which I understand is fairly common. I was hoping to make it through life without ever needing a colonoscopy, but no such luck.

I definitely like the concept of preventative tests, although I can see that it might not be the most cost effective way to go. I've had a couple of situations where preventative tests found some serious (ie. potentially deadly) issues, and saved my life. I'm sure I'm not going to make it to my FIRE planned 95 years, but I'm not quite ready to check out yet either. I'm not on ACA, so the judge's decision isn't a big deal for me, but I hope it gets overturned so others can have the same options I've had.

 

[Montecfo]

I read the articles. Twice. It’s not the math, but it might be the reading.



As a finance guy, you might have your arms around the differences between cost saving, cost effectiveness and cost benefit. I didn't and the CDC website helped me better understand the articles you cited. https://www.cdc.gov/policy/polaris/economics/index.html. The Times article says that two of the required ACA services (childhood immunizations and counseling adults in the use of aspirin) were “cost saving” and an additional 15 (which were not defined) were “cost effective.” https://www.nytimes.com/2018/01/29/upshot/preventive-health-care-costs.html The Reuters article is similar. https://www.reuters.com/article/us-preventive-economics-idUSBRE90S05M20130129 It says that the U.S. Preventive Services Task Force (the group that the trial court found was unconstitutional) didn't include screening for ovarian and testicular cancer in their recommendations because it had no health benefit. So it seems like they weren't just rubber stamping preventative measures.



Neither article says that the ACA's requirements are not cost-effective or a waste of money. They say, and we probably all agree, that we should select only high-risk people for screening, that some alternative programs show promise, and that not every preventative measure is effective. They also say, as do other commenters here, that this is not a simple dollars in, dollars out exercise. Cost-effectiveness isn't always the right yardstick.



BR

Well, I know I benefit from my effort to learn more about this. The point I started with as USGrant1962 was kind enough to reiterate above, is that preventative care is not always cost effective.

It is a small but I think an important point. That all the required elements of ACA are not in there because they save money. Some do. Some are there due to a perception of benefit. ACA makes these tests free to the entire population. There is no selection or risk assessment to make them more cost effective. Suggesting they should do that is a great idea. But that is not how it works. ACA is one size fits all.

Thanks for advancing the discussion.

 

[bigreader]

I have another observation.

The ACA does not make all preventative measure available to the entire population.

This is from the CDC's list of screenings that are done without a co-pay (sorry for the lousy formatting) https://www.healthcare.gov/preventive-care-adults/

​

1. Abdominal aortic aneurysm one-time screening for men of specified ages who have ever smoked

​

2. Alcohol misuse screening and counseling

​

3. Aspirin use to prevent cardiovascular disease and colorectal cancer for adults 50 to 59 years with a high cardiovascular risk

​

4. Blood pressure screening

​

5. Cholesterol screening for adults of certain ages or at higher risk

​

6.Colorectal cancer screening for adults 45 to 75

​

7.Depression screening

​

8.Diabetes (Type 2) screening for adults 40 to 70 years who are overweight or obese

​

9. Diet counseling for adults at higher risk for chronic disease

​

10. Falls prevention (with exercise or physical therapy and vitamin D use) for adults 65 years and over, living in a community setting

​

11. Hepatitis B screening for people at high risk, including people from countries with 2% or more Hepatitis B prevalence, and U.S.-born people not vaccinated as infants and with at least one parent born in a region with 8% or more Hepatitis B prevalence.

​

12. Hepatitis C screening for adults age 18 to 79 years

​

13. HIV screening for everyone age 15 to 65, and other ages at increased risk

​

14. PrEP (pre-exposure prophylaxis) HIV prevention medication for HIV-negative adults at high risk for getting HIV through sex or injection drug use

​

15. Immunizations for adults — doses, recommended ages, and recommended populations vary:

Chickenpox (Varicella)
Diphtheria
Flu (influenza)
Hepatitis A
Hepatitis B
Human Papillomavirus (HPV)
Measles
Meningococcal
Mumps
Whooping Cough (Pertussis)
Pneumococcal
Rubella
Shingles
Tetanus​

16. Lung cancer screening for adults 50 to 80 at high risk for lung cancer because they’re heavy smokers or have quit in the past 15 years
​

The only screenings available for all adults are for alcoholism, high blood pressure and depression. Note that a "screening" might be a conversation, not a lab.
Is there some other information that I missed showing that the things on this list are offered to everyone and/or not cost effective or beneficial?

BR

 

[Montecfo]

I have another observation.



The ACA does not make all preventative measure available to the entire population.



This is from the CDC's list of screenings that are done without a co-pay (sorry for the lousy formatting) https://www.healthcare.gov/preventive-care-adults/

​

1. Abdominal aortic aneurysm one-time screening for men of specified ages who have ever smoked

​

2. Alcohol misuse screening and counseling

​

3. Aspirin use to prevent cardiovascular disease and colorectal cancer for adults 50 to 59 years with a high cardiovascular risk

​

4. Blood pressure screening

​

5. Cholesterol screening for adults of certain ages or at higher risk

​

6.Colorectal cancer screening for adults 45 to 75

​

7.Depression screening

​

8.Diabetes (Type 2) screening for adults 40 to 70 years who are overweight or obese

​

9. Diet counseling for adults at higher risk for chronic disease

​

10. Falls prevention (with exercise or physical therapy and vitamin D use) for adults 65 years and over, living in a community setting

​

11. Hepatitis B screening for people at high risk, including people from countries with 2% or more Hepatitis B prevalence, and U.S.-born people not vaccinated as infants and with at least one parent born in a region with 8% or more Hepatitis B prevalence.

​

12. Hepatitis C screening for adults age 18 to 79 years

​

13. HIV screening for everyone age 15 to 65, and other ages at increased risk

​

14. PrEP (pre-exposure prophylaxis) HIV prevention medication for HIV-negative adults at high risk for getting HIV through sex or injection drug use

​

15. Immunizations for adults — doses, recommended ages, and recommended populations vary:

Chickenpox (Varicella)

Diphtheria

Flu (influenza)

Hepatitis A

Hepatitis B

Human Papillomavirus (HPV)

Measles

Meningococcal

Mumps

Whooping Cough (Pertussis)

Pneumococcal

Rubella

Shingles

Tetanus​

16. Lung cancer screening for adults 50 to 80 at high risk for lung cancer because they’re heavy smokers or have quit in the past 15 years

​

The only screenings available for all adults are for alcoholism, high blood pressure and depression. Note that a "screening" might be a conversation, not a lab.

Is there some other information that I missed showing that the things on this list are offered to everyone and/or not cost effective or beneficial?



BR

Well the most familiar and in many cases the more costly examples of covered preventative care
Jare not on this list, namely physicals, colorectal cancer screenings, mammography, contraception etc.

But the larger point, which you seem to be disputing, is that preventive care is often not cost effective. This is a rather well established fact from what I understand.

If you disagree then feel free to make your case directly. But in the context of the thread topic, we appear to be in the weeds.

 

[waynezo]

This is not R vs D. This is not political. This is one single person deciding to reverse long-fought-for legislation, just because they are power-tripping. This is cherry-picking judges, many who are not qualified. It makes me want to go to law school and become a judge. After 30 years of saving the lives of babies and children, I think I know right from wrong, more than some of these judges do.

It’s about saving lives and improving the quality of life for all of us.

Please don’t bring Porky in too soon. I’m crying over this.

Who is Porky?

 

[waynezo]

Preventive care is how other developed nations provide better results at lower costs. It costs less to give a poor person cholesterol and high blood pressure medicine than to perform open heart surgery on them.

 

[Walt34]

Who is Porky?

This is Porky, who usually makes an appearance as the last post in a thread that has been closed because it "went off the rails" as in becomes argumentative, political, or otherwise tends to incite an online flame war.

This thread is not closed. This is just the example to make the introduction for a relatively new member.

 

[Gumby]

Who is Porky?

Our resident Sus terminatore.

 

[MC Rider]

Preventive care is how other developed nations provide better results at lower costs. It costs less to give a poor person cholesterol and high blood pressure medicine than to perform open heart surgery on them.

I have one of each there. Had to pay cash from pocket for a bit, it was about $70 per month. How much is heart surgery? How many more zeros do you add?


So, I agree with you.

 

[bigreader]

Well the most familiar and in many cases the more costly examples of covered preventative care
Jare not on this list, namely physicals, colorectal cancer screenings, mammography, contraception etc.

But the larger point, which you seem to be disputing, is that preventive care is often not cost effective. This is a rather well established fact from what I understand.

If you disagree then feel free to make your case directly. But in the context of the thread topic, we appear to be in the weeds.

I am not so sure that we are in the weeds. We all agree: some preventive care is not cost-effective, or beneficial. But you keep trying to argue that the ACA requires a number of preventative services that are "open to everyone" and are not cost-effective. Your argument is that since some preventative measures are not cost effective, the preventative service in the ACA are mainly a waste of money. However, three is no link between the services you cite as not cost effective and what the ACA requires.

I hope that at some level I have shown that the covered preventative service are not open to everyone. They seem to be structured to address the cost benefit question that seems to trouble you so deeply. You might be interested to see that ACA preventative services for women, like mammograms are tailored to a high risk population. https://www.healthcare.gov/preventive-care-women/

I take it that you don't like the ACA. I take it that you don't think that things like contraception, colonoscopies, and mammograms should be covered with no copay (or maybe at all?). You are absolutely entitled to that position but it is hard for me to see that it is based upon a rational cost benefit analysis.

Finally, if insurance companies didn't cover these services pre-ACA, it doesn't mean they weren't cost effective or beneficial. It might just mean that they didn't think they would make money for the insurance company.

 

[Montecfo]

I am not so sure that we are in the weeds. We all agree: some preventive care is not cost-effective, or beneficial. But you keep trying to argue that the ACA requires a number of preventative services that are "open to everyone" and are not cost-effective. Your argument is that since some preventative measures are not cost effective, the preventative service in the ACA are mainly a waste of money. However, three is no link between the services you cite as not cost effective and what the ACA requires.



I hope that at some level I have shown that the covered preventative service are not open to everyone. They seem to be structured to address the cost benefit question that seems to trouble you so deeply. You might be interested to see that ACA preventative services for women, like mammograms are tailored to a high risk population. https://www.healthcare.gov/preventive-care-women/



I take it that you don't like the ACA. I take it that you don't think that things like contraception, colonoscopies, and mammograms should be covered with no copay (or maybe at all?). You are absolutely entitled to that position but it is hard for me to see that it is based upon a rational cost benefit analysis.



Finally, if insurance companies didn't cover these services pre-ACA, it doesn't mean they weren't cost effective or beneficial. It might just mean that they didn't think they would make money for the insurance company.

Most of what you are concluding is different than my point. I have no axe to grind here. You have gotten rather exercised here, not sure why.

I have made my point several times. It sounds like you agree. To me, that is success. I see no need to belabor it. But I hope at some point in the future we can discuss this or some other matter in a way that is more enjoyable all things considered.

All the best.

 

[USGrant1962]

Preventive care is how other developed nations provide better results at lower costs. ...

I would like to see a citation for that. As I understand it, the US spends way more than most countries on preventive screening, tests, etc. - especially very expensive screening like MRIs. It is part of why the US medical system is more expensive. Another part is that we spend more on end-of-life care and on elective procedures like hip and knee replacements. Lastly, our medical professionals are paid more. It is complicated.

The "worse outcomes" in the US is mostly explained by lifestyle choices. For example, the US has the highest obesity and opioid OD rates.

Here's an interesting rundown from before Covid: https://www.commonwealthfund.org/pu...20/jan/us-health-care-global-perspective-2019

The U.S. outperforms peer nations in terms of preventive measures. In the U.S., more than two-thirds of adults 65 and older had a flu vaccine in 2016, considerably more than in the average OECD country. Only the U.K. had a higher rate than the U.S. At the lower end of the spectrum, one-third of older adults in Germany and Norway received the vaccine.

The U.S. also had one of the highest rates of women ages 50 to 69 being screened for breast cancer. The U.S. rate is considerably higher than the OECD average. In contrast, in Switzerland, France, and Germany, only half of women this age had been screened.

 

[waynezo]

My neighbor worked for construction subcontractors his whole life and had no access to healthcare. He was not lazy. After the ACA came around he got a colonoscopy. He was diagnosed with stage 4 colon cancer. He died soon after. There will always be fraud and abuse in any Government Program. However I believe the richest country on earth can afford preventative medicine not just for it's poorest citizens, but for it's working citizens as well.

 

[tennisno1]

This is a bit of a subset of this conversation but I think its illustrative of the complexity of preventive care policies. It's all about the details. Even when we think things are " covered" by policy they may not be.

Prior to 2023 if you had a positive Cologuard test in most cases you were on the hook for cost sharing on the follow up of a colonoscopy if you had one. It took 8 years since this test was launched to make this Medicare / ACA coverage decision. Certain commercial insurance plans could be exempt from this. I share this in the spirit of its all about the details in preventive care requirements. For many people the cost share for a colonoscopy post positive cologurd was cost prohibitive and they went without it, with all the risks this entails.

Medicare and Insurance Policy Updates in 2023 Will Improve Cancer Screening Access by Removing Patient Colonoscopy Cost Following a Positive Cologuard Test

https://www.prnewswire.com/news-rel...uire Medicare,effect starting January 1, 2023.

 

[Alan]

This thread was about ACA insurance coverage of preventative care. The snarky posts about the ACA in general were disruptive and off-topic. Some have been removed and now we have decided that this interesting thread has run its course.