A broad range of preventive health services provided at no cost to patients — one of the most critically important aspects of the Affordable Care Act (ACA) — is now in jeopardy following a federal judge’s ruling inBraidwood Management Inc. v. Becerra. This deeply flawed decision flies in the face of sound public health policy, and the human, financial, and societal costs of establishing barriers to preventive services are immeasurable.
The ACA has withstood a host of challenges within the courts and in Congress, including a 2018 ruling (later overturned) by this same judge that found the entire ACA unconstitutional. The ACA remains the law of the land, with three U.S. Supreme Court decisions in its favor. But in an opinion issued in September 2022, U.S. District Judge Reed O’Connor ruled that requiring some employers to provide coverage for drugs that prevent HIV transmission, such as pre-exposure prophylaxis (PrEP), violated their rights under the Religious Freedom Restoration Act.
Providing no-cost insurance coverage for drugs that prevent the transmission of infectious disease does not violate anyone’s religious freedom. On the contrary, this and other types of preventive care save countless lives.
The data are clear: PrEP works, reducing the risk of contracting HIV from sex by about 99 percent, according to the Centers for Disease Control and Prevention. Fourteen randomized control trials demonstrate its effectiveness in preventing HIV. The counseling that physicians provide when prescribing PrEP further helps patients make informed choices about how they want to manage their medication in the context of their own risks, exposures, and social determinants of health.
Judge O’Connor’s subsequent remedy order, issued March 30, dealt a blow to not only the PrEP coverage requirements, but also the broader mandate that private insurers must provide first-dollar coverage for a wide range of preventive services, including screenings for the early detection of cancer, hypertension, diabetes, and infections.
Millions of patients could lose no-cost access to cholesterol treatment, tobacco and alcohol cessation, immunizations, and childhood screenings for lead poisoning, hearing loss, and autism. The judge held that the requirement to cover certain preventive services with an A or B rating recommended by the U.S. Preventive Services Task Force since 2010 is invalid because of the way that panel of medical experts was created.
Physicians know the inevitable result if courts begin to interfere with insurance coverage of effective, proven treatments like PrEP and other preventive care — our patients will be subjected to needless illness and preventable deaths.
Providing first-dollar insurance coverage for screenings and interventions that prevent disease saves lives — period. Eliminating this option threatens tools physicians use every day to improve the health of our patients.
And the burden of losing no-cost coverage will fall disproportionately on historically marginalized communities who are least able to afford it and are often at high risk of developing preventable medical conditions. In the case of PrEP, this flawed court decision unconscionably threatens to exacerbate inequities that sexual and gender minorities already face.
We all know the dramatic differences that preventive care can make, just as physicians know that uninsured individuals live sicker and die younger. The twin goals of extending health coverage to the uninsured while making coverage more affordable to all continue to be priorities for the AMA as we work to improve the health of our nation.
We strongly urge employers and insurers to maintain this first-dollar coverage for preventive services while legislative and judicial remedies are considered.
Jack Resneck Jr., MD, is the president of the American Medical Association.
Views expressed in The Advocate’s opinion articles are those of the writers and do not necessarily represent the views of The Advocate or our parent company, equalpride.
