Loss of ACA Preventive Assistance mandate could impact 10 million enrollees

By Kelsey Waddill

– With the Affordable Care Act\’s preventive care coverage requirement under scrutiny, Peterson-KFF researchers investigated how many Americans rely on the law\’s coverage and determined that up to 10 million people could be affected.

The researchers used data on claims from 2019, which would not be susceptible to the impact of the coronavirus pandemic, to evaluate the use of preventive assistance services.

The district court ruling specifically targeted recommendations from the US Preventive Services Task Force (USPSTF), saying that employers offering employer-sponsored private health plans should not be required to fully cover all drugs. and the preventive services that the Affordable Care Act (ACA) requires. The court found this requirement unconstitutional.

Given the district court\’s focus, the researchers also focused the study on USPSTF recommendations. They observed the use of certain drugs and services that had changes in USPSTF recommendations after the implementation of the ACA.

This included statin drugs for adults ages 40 to 75 at risk for cardiovascular disease, lung cancer screenings for American adults, hepatitis C screenings for adults 22 years of age and older, and hepatitis B screenings for non-pregnant and at-risk adults in the same age group, and drugs that reduce the risk of breast cancer for women 35 years of age and older who are at risk.

The study covered preventive care utilization for these drugs and services across all private markets, including large and small employer markets and individual health insurance markets.

\”If the Fifth Circuit Court hold is reversed and the district court\’s decision is upheld by a higher court, insurers would be allowed to introduce cost sharing for all affected preventative services and drugs or exclude coverage altogether, although the latter appears to be the least likely scenario,\” the researchers determined.

Overall, 5.7% of private payer market enrollees have relied on preventive care services covered by the ACA. That percentage represents about 10 million Americans, or one in 20 enrolled in the private payer market.

The share was highest in the individual health insurance market, where 7.0% of individuals used preventive care services covered by the ACA. In addition, 5.7% of large employer enrollees and 4.1% of small employer enrollees used ACA preventive care.

The results overwhelmingly reflected statin use. Statin use accounted for 4.8% of collective ACA preventive care use.

However, the researchers indicated that the results may look different after 2019. After 2019, the USPSTF made major changes like recommending PrEP and colorectal cancer screenings. Additionally, the impact could increase with each new USPSTF recommendation.

An earlier study by Peterson-KFF found that six out of ten Americans used preventive care services under the ACA coverage mandate. Using data from 2018, the study found similar trends in preventive care utilization across markets. Vaccinations, wellness visits, and screenings accounted for the majority of preventive care services used by Americans. About 70% of children with private health insurance coverage used preventive care, and the same percentage of young women.

The district court ruling that the ACA\’s requirement for preventive care services was unconstitutional occurred in March 2023. The Biden administration has since appealed the decision, and the appellate court has stayed. of this sentence until the resolution of the dispute.

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