Family doctors say preventive care ruling ‘will jeopardize health outcomes’

The Texas case involves a provision of the ACA that doctors say is critical for millions of Americans.

The American Academy of Family Physicians (AAFP) has endorsed a court ruling that could stifle access to free health screenings and medical services for patients.

The decision of September 7 in the case of the so-called Kelley v. Becerrain the U.S. District Court-Northern District of Texas struck down part of the federal Affordable Care Act (ACA) that required insurers and employers to cover HIV prevention drugs, according to The hill. The plaintiffs challenged the ACA’s mandate that health insurance cover pre-exposure prophylaxis, or PrEP, the drugs for free, arguing that they did not need or want the coverage and that the policies violated the Religious Freedom Restoration Act, according to the complaint published in Bloomberg Law.

Decision “is concerned”, the academy’s official Twitter account said. “If this decision remains in place, patients face higher costs and limited access to preventive health services such as cancer screening,” the tweet said.

It included a statement from AAFP President Sterling N. Ranson Jr., MD, FAAFP, who said “family physicians are alarmed by the US District Court’s decision.”

If it remains, “it will jeopardize health outcomes by creating financial barriers to the screenings, counseling and preventive medications that improve patient health,” Ranson said in the statement. “AAFP urges legislators, insurers and health plan sponsors to ensure that patients can continue to have access to high-quality, essential preventive services without cost-sharing.”

For months, doctors and analysts have argued that the case could have widespread implications for health services across the country.

This summer, the American Medical Association (AMA) issued a joint statement with dozens of medical groups arguing the case’s potential to harm the health care of millions of people. In 2020, approximately 151.6 million people had private health insurance benefiting from the provisions of the ACA. The AMA cited that figure, which was included in a brief from the U.S. Department of Health and Human Services’ Office of Health Policy, Assistant Secretary for Planning and Evaluation.

“With an unfavorable decision, patients will lose access to vital preventive health services such as screening for breast cancer, colorectal cancer, cervical cancer, heart disease, diabetes, pre-eclampsia and hearing, as well as access to immunizations that are critical for maintenance of a healthy population,” the organizations wrote in the July 26 joint statement. “Our patients cannot afford to lose this critical access to preventive health services. Revoking this access would reverse important progress and make it harder for doctors to diagnose and treat diseases and medical conditions that, if detected early, are significantly more manageable.

The Commonwealth Fund, the Robert Wood Johnson Foundation, and the Urban Institute have published analyzes of the effects of preventive services on patients and the legality of federal rules.

If the preventive services rule is repealed, medical care itself does not necessarily disappear.

But “private health plans will be able to charge cost-sharing for these life-saving services,” the Urban Institute report said, and some insurers and health plans “may choose to eliminate coverage for certain services altogether or require cost-sharing for care,” according to the Commonwealth Fund.

“These changes will increase out-of-pocket costs for millions of Americans, leading to reduced access to preventive care, worsening long-term health outcomes, and widening health care disparities,” said the Commonwealth Fund’s report, “The Latest Legal Challenge to the Guarantee for Affordable Care Act preventive services.”

Health insurance cost experts made similar predictions based on the decision, according to a report by the Managed Healthcare Executive.

Studies and news reports note that Judge Reed O’Connor has issued several rulings on the ACA, including a finding that the entire act is invalid, a ruling that the US Supreme Court overturned in 2021.

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