New Rules on Preventive Care Under the Affordable Care Act

A judge in Fort Worth, Texas, ruled on a case challenging the ACA requirement for preventative healthcare coverage with no out-of-pocket costs for the policyholder. He struck down the requirement for HIV prevention drugs, cancer screenings, and alcohol abuse counseling. Clearsurance.com health insurance expert Melanie Musson evaluates insurance providers’ potential responses.

The medical community has been buzzing for several weeks, waiting for a judge in Texas to rule on a case concerning the Affordable Care Act (ACA) and its preventative care coverage mandate affecting both private insurers and Medicare insurance plans.

Insurance providers don’t have to discontinue full coverage for preventative care if the mandate is lifted, but they’ve been weighing the benefits and downsides of doing so. Now they’ll have to take their considerations more seriously because the judge just handed down the ruling.

HIV Prevention Drugs Mandate Deemed Unconstitutional

According to Reuters, “Ruling in Fort Worth, Texas, U.S. District Judge Reed O’Connor found that the HIV pre-exposure prophylaxis, or PrEP, mandate stemmed from a recommendation by an advisory body formed in violation of constitutional requirements and could infringe upon the rights of employers under a law called the Religious Freedom Restoration Act.”

Several years ago, in a similar case, another judge ruled in favor of religious freedom versus mandated contraception coverage.

The judge’s recent ruling in Texas is on the specific case brought before him, and insurance providers will have to wait to see if the ruling is applied nationally or only to the company that brought the lawsuit.

Insurance Providers Must Evaluate Their Continuing Coverage for Preventative Healthcare

Several other preventative care requirements were also included in the lawsuit, and the judge upheld some and not others. The New York Times explains that mandated coverage for HIV prevention drugs, cancer screenings, and alcohol abuse counseling is in jeopardy.

That may cost them more in the long run, though, because individuals may skip preventative screenings because they don’t want to pay for them.

That could cost insurance providers more money. For example, if someone finds out they have cancer in the early stages, the treatment will tend to cost less than someone who receives a diagnosis of stage four cancer requiring extended chemo and radiation treatments.

So, while waiting to see how this ruling affects all insurance providers, each provider must evaluate and find the best response to potential changes in requirements.