Judge Strikes Down ACA's Required Coverage Of Preventive Care

[Gumby]

I am unfamiliar with the court case and cannot comment on it.

But I can say that some insurance companies believe that preventative care actually saves them money. My insurer has a list of preventative care requirements that the young wife and I must complete - such as annual visits with our primary care physician, annual dental cleaning, cholesterol screening every so many years, eye exams every so many years, mammogram, colonoscopy, etc. If we fail to meet the requirements in a particular year, our premium gets raised by $100 per month per person for the next year.

 

[youbet]

The issue is that PSTF has zero oversight and their recommendations automatically become law.

Thanks. That makes more sense.

 

[youbet]

I can say that some insurance companies believe that preventative care actually saves them money. .

I know DW's Advantage plan pays for her health club membership and sends her Visa reward cards for getting certain preventative tests done in a timely way.

 

[MichaelB]

Here’s the US Preventative Services Task Force list of recommended preventive services (here). All of the ACA preventative services are on its list.

It does not show a list of recommended vaccinations. Instead it refers readers to the CDC.

 

[Aerides]

All they have to do is things like... charge for breast cancer, prostate screening, etc., and if those are no longer included with no cost people will forgo them.

Not people here, not people with means, mostly, but those without the finances to pay their hefty portions. My annual mammogram would cost me hundreds of dollars vs. not.

We won't know today which plans might be different next year, but you can be sure that lawyers and actuaries are in meetings right now talking about it.

 

[youbet]

Here’s the US Preventative Services Task Force list of recommended preventive services (here). All of the ACA preventative services are on its list.

It does not show a list of recommended vaccinations. Instead it refers readers to the CDC.

Looks like you have to be careful with this list as some of the listings, when you click on them and read the details, are NOT recommended. For example, since I have AFIB, I clicked on that one and their recommendation was that screening for non-asymptomatic adults (that was me) was not recommended.

You see

Atrial Fibrillation: Screening

and click on it expecting that screening is covered and you'll be told details. But, you get:

The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for atrial fibrillation.

So just saying it looks like not everything on this list is a recommended preventative care screening by the USPSTF. It might be a listing of all the things they've considered but some are not recommended in the end. Or a subset of the population might be recommended for the screening. It's still a useful list, but check the details of the specific you're interested in. My AFIB was caught by a simple, cheap EKG as part of a routine checkup.

 

[Irishgirlyc58]

Most preventive screenings cost more to administer than the diseases they diagnose or prevent.

That is why most commercial insurance did not cover as much as ACA mandated.

Is that because dead people don’t cost the insurance companies anything?

 

[aaronc879]

All they have to do is things like... charge for breast cancer, prostate screening, etc., and if those are no longer included with no cost people will forgo them.

Not people here, not people with means, mostly, but those without the finances to pay their hefty portions. My annual mammogram would cost me hundreds of dollars vs. not.

We won't know today which plans might be different next year, but you can be sure that lawyers and actuaries are in meetings right now talking about it.

Google says the average cost of a colonoscopy without insurance is $3,000. I can say with 100% certainty that I would go without rather than pay that out of pocket. Combined with mammograms not being covered there will be a massive rise in cancer and at later stages. This is a horrible and reckless decision by a rouge Judge and HAS to be undone.

 

[MichaelB]

So just saying it looks like not everything on this list is a recommended preventative care screening by the USPSTF. It might be a listing of all the things they've considered but some are not recommended in the end. It's still a useful list, but check the details of the specific you're interested in. Mine was caught by a simple, cheap EKG as part of a routine checkup.

Right, but it does look like all the preventative services and screenings included in the ACA are on the recommended screenings list by USPTF.

Have you ever seen a listing of what insurance companies allow as charges for any of the above? For example, my GP always takes my BP and yells at me about my boozing and flab no matter why I'm there. I'm wondering, because doing those things are listed in your post above, if he's getting some payment for including them even though I'm there because my knee is swollen.

I think no one has ever seen that list, it’s confidential to each insurer and must vary between insurers and locations. I imagine, though, that everything is reimbursed. After all, the ACA mandate what insurance policies must cover, not what services physicians must provide.

As for the BP and boozing, I’ll tell you to take it easy - and no charge.

 

[youbet]

Google says the average cost of a colonoscopy without insurance is $3,000. I can say with 100% certainty that I would go without rather than pay that out of pocket. Combined with mammograms not being covered there will be a massive rise in cancer and at later stages. This is a horrible and reckless decision by a rouge Judge and HAS to be undone.

I might be mistaken on this, but isn't it an issue of whether you'll have a deductible or co-pay as opposed to having to pay the entire cost as an uncovered medical expense?

I hope I'm not wrong on this, but I doubt we'll be seeing Medicare, Medicaid and private insurance companies dropping coverage for colonoscopies altogether.

 

[bigreader]

Most preventive screenings cost more to administer than the diseases they diagnose or prevent.

That is why most commercial insurance did not cover as much as ACA mandated.

I am interested in your basis for your first sentence. Can you point me in the direction of your research?
Thanks, BR

 

[copyright1997reloaded]

From the Bloomberg article above:

The issue is that PSTF has zero oversight and their recommendations automatically become law.

The constitution is a pesky thing...

 

[Aerides]

I might be mistaken on this, but isn't it an issue of whether you'll have a deductible or co-pay as opposed to having to pay the entire cost as an uncovered medical expense?

I hope I'm not wrong on this, but I doubt we'll be seeing Medicare, Medicaid and private insurance companies dropping coverage for colonoscopies altogether.

If you have a deductible - for example, last year my sister's routine mammogram was coded as diagnostic instead of routine preventative. Her bill was $1500 instead of nothing (she has a $2k deductible). She spent months fighting to get it corrected...

 

[athena53]

As Aerides pointed out in Post #2, this will be appealed. Insurance is regulated by the states and your policy cannot be changed mid-term by a Supreme Court decision so nothing will happen now and nothing in the decision REQUIRES that the tests not be covered by ACA- just says that they're not required to be covered.

I'm a retired property-casualty actuary and the hard math will likely show that many tests ARE cost-effective. What's the cost of a simple lumpectomy or bowel resection followed by chemo (not easy on the individual, I know) compared to more drastic surgery, chemo, radiation, maybe an attempt at immunotherapy, more surgery/chemo when it metastasizes, over a period of a couple of years? Those savings would pay for boatload of preliminary screenings. It's entirely possible that companies will decide to continue coverage because it makes economic sense.

 

[MC Rider]

We can hope common sense wins out over stupid. Not much else I can do except vote.

 

[youbet]

It's entirely possible that companies will decide to continue coverage because it makes economic sense.

It's also possible that our politicians will find a way to restructure the USPSTF so that they can have the power to mandate this coverage within constitutional boundaries. Or a higher court will rule that the USPSTF, as it currently exists, is constitutional and may work with absolute authority and without oversight.

The judge really didn't rule on the worth-wildness of any particular preventative procedures. He said that the USPSTF committee existed and was working outside of constitutional parameters and was therefore not entitled to make these mandates that insurance companies must cover the procedures without co-pays or deductibles.

As the case moves forward in the judicial system, won't the constitutional questions be on stage as opposed to the efficacy of the various preventive testing procedures?

 

[11522914]

It's also possible that our politicians will find a way to restructure the USPSTF so that they can have the power to mandate this coverage within constitutional boundaries. Or a higher court will rule that the USPSTF, as it currently exists, is constitutional and may work with absolute authority and without oversight.

The judge really didn't rule on the worth-wildness of any particular preventative procedures. He said that the USPSTF committee existed and was working outside of constitutional parameters and was therefore not entitled to make these mandates that insurance companies must cover the procedures without co-pays or deductibles.

As the case moves forward in the judicial system, won't the constitutional questions be on stage as opposed to the efficacy of the various preventive testing procedures?

+1

 

[bigreader]

Court's Original Order

Today's decision was based on an order granting summary judgement that was filed in September. Summary judgement is a way to get to a resolution of an issue without trial. It is pretty common in cases where there is no real factual disputes. I found the summary judgement order here: https://storage.courtlistener.com/recap/gov.uscourts.txnd.330381/gov.uscourts.txnd.330381.92.0_1.pdf

The case was brought by a group of people and a business some of whom "want the option to purchase health insurance that excludes or limits coverage of PrEP drugs, contraception, the HPV vaccine, and the screenings and behavioral counseling for STDs and drug use" and/or other services they would not use, like pregnancy care or dental care for kids under 5. Seems like their reasoning was religious in some cases, economic in others.

Some, but not all, of the preventative services in the ACA come from the USPSTF, a group of volunteer professionals. Insurers must include all of the services USPSTF has graded "A" and "B." You can find the list of the services here. https://www.uspreventiveservicestas...ndation-topics/uspstf-a-and-b-recommendations. They include things like breast, colon and cervical cancer screenings, a number of STD screenings and treatments including the use of PrEP for high risk patients.

The court made two findings in September.

First, it found that the USPSTF was not properly appointed and the recommendations are not binding. I take that to mean that an insurer no longer needs to offer any of the "A"and "B" services without copay in future contracts.

Second, the court found that the mandate for services for AIDS (PrEP) violates the rights of one of the plaintiffs since he believes that PrEP encourages homosexuality and sexual relationships outside of marriage in violation of his Christian beliefs.

Porky lurks, so I will try to be careful, but I often pay for things that I won't ever need or use because I am a beneficiary of a larger community that is different from me. I can't imagine why anyone would wish poor health on any community member.
BR

 

[pb4uski]

Most preventive screenings cost more to administer than the diseases they diagnose or prevent.



That is why most commercial insurance did not cover as much as ACA mandated.

You got a cite for that because I certainly don't remember it that way.

 

[pb4uski]

... It seems to hinge on a previous decision that declared the recommendation committee to be unlawful because appointments weren't subject to Senate confirmation and recommendations have no elected official oversight. This decision goes to the remedy. ...

Is there any evidence that the recommendation committee abused the authority that was granted to them by statute or is it more of some sort losers making a complaint based on a technicality? Did the insurers who had to include these preventative services object? Were the services generally included before ACA?

Given how dysfunctional Congress is perhaps "no elected official oversight" isn't bad.

 

[pb4uski]

Is that because dead people don’t cost the insurance companies anything?

That may be true but dead people don't pay premiums either.

 

[Sue J]

Google says the average cost of a colonoscopy without insurance is $3,000. I can say with 100% certainty that I would go without rather than pay that out of pocket. Combined with mammograms not being covered there will be a massive rise in cancer and at later stages. This is a horrible and reckless decision by a rouge Judge and HAS to be undone.

Just for reference. My Cologuard test in 2021 was billed as $681 and Medicare approved and paid $509. I had already met my (very small compared with ObamaCare) deductible so I paid nothing.

aaron879 makes a very good point. Would I pay $3000 every 10 years for a colonoscopy? Maybe. I think I would definitely pay for the Cologuard at $500.

I remember when breast cancer was something said in a whisper. And how Katie Couric changed the whole topic of colon cancer after her husband died from it quite young. She made it not so icky and educated us about detection and prevention.

I think the preventative tests for colon cancer and breast cancer have made huge differences in the lives of many people. I hope preventative care continues to be covered in full.

 

[Irishgirlyc58]

That may be true but dead people don't pay premiums either.

But they don’t want sick people do they?

 

[youbet]

Is there any evidence that the recommendation committee abused the authority that was granted to them by statute or is it more of some sort losers making a complaint based on a technicality? Did the insurers who had to include these preventative services object? Were the services generally included before ACA?

Given how dysfunctional Congress is perhaps "no elected official oversight" isn't bad.

The "losers" are those now whining about an "outside the constitution" situation existing and unwilling to quickly and simply correct it.

 

[Montecfo]

You got a cite for that because I certainly don't remember it that way.

"Preventative Care Saves Money? Sorry It's Too Good to Be True."

https://www.nytimes.com/2018/01/29/upshot/preventive-health-care-costs.htm

"Think Preventative Care Will Safe Money? Think Again"

https://www.reuters.com/article/us-preventive-economics-idUSBRE90S05M20130129

Bottom line is it is a mixed bag. Some preventative medicine is very cost effective, like taking a baby aspirin daily to prevent heart attack. Also, some vaccinations. Others such as annual physicals and some cancer screenings are not cost effective.