EXPERTS ADVISORY

A Texas federal judge ruled Thursday against a part of the health care law that promises free preventive services to every American who has private health insurance.

Judge Reed O’Connor of the U.S. District Court for the Northern District of Texas granted Braidwood Management Inc.’s request to block Section 2713 of the Public Health Service Act as amended by the ACA, that requires coverage without cost-sharing of preventive services to which the U.S. Preventive Services Task Force assigns a rating of A or B.

O’Connor ruled that recommendations from the USPSTF are unconstitutional because the task force is not appointed by the president and confirmed by the Senate.

University of Michigan experts can discuss:

A. Mark Fendrick is a professor of internal medicine at the Medical School and professor of health management and policy at the School of Public Health. He conceptualized and coined the term Value-Based Insurance Design and currently directs the V-BID Center at U-M. His research focuses on how clinician payment and consumer engagement initiatives impact access to care, quality of care and health care costs.

Fendrick helped draft the preventive care mandate, one the most popular ACA provisions, and has evaluated the clinical equity and financial impact. It has increased screenings, improved health outcomes, and reduced racial disparities. The U.S. Department of Health and Human Services estimates 152 million Americans have had access to additional preventive care with zero cost-sharing.

“Requiring patients to pay significant amounts out-of-pocket for high-quality preventive services shouldn’t be a partisan issue,” he said. “Whether you’re a Democrat or a Republican, it’s just good policy to promote access to services that have been proven to prevent diseases or to detect conditions while they’re still treatable.”

Contact: amfen@umich.edu

Nicholas Bagley, professor of law at Michigan Law, teaches and writes in the areas of administrative law, regulatory theory and health law, with a focus on Medicare and the implementation of the Affordable Care Act. His writings on the King v. Burwell case helped advance public discourse on whether ACA subsidies were available nationwide or only in those states that established their own exchanges. He continues to consider questions pertaining to the legality of the complex rollout of the ACA.

“Politically, getting any bipartisan compromise on anything touching the Affordable Care Act could be hard. But the preventive services mandate is wildly popular across the political spectrum,” he said. “As for how employers and insurers will react to the decision, we don’t really know. Many will still abide by the most recent guidelines, both because preventive care is often cheap and people are used to zero-dollar coverage.”

Contact: nbagley@umich.edu

Related commentary by Fendrick and Bagley:
A Texas Judge Just Invalidated The Preventive Services Mandate. What Happens Next?