On Tuesday, the Supreme Court cited shoes at the Kennedy V. Braidwood Management. ACA (AFODABLE CARE ACT) regulations require employers to deal with USPSTF approval prevention treatment without cost sharing. The final decision of the Supreme Court can make an important decision on employers for insurance coverage for preventive treatment.
The District Court was inappropriate for the plaintiff because the USPSTF was not appointed by the Constitution, and the Fifth Court of Appeals supported this discovery. The plaintiff also had to provide the guarantee of oral contraceptives and HIV prevention drugs (Prep) based on religious beliefs, and the Court of Appeals sent this issue to the District Court for further analysis without decisions on advantages.
The Supreme Court has some options in this case. You may be able to rule narrowly or extensively to the plaintiff, or avoid rule or substantial ruling. Narrow ruling on the plaintiff can only be applied to certain situations, and preventive nursing regulations remain intact for other employers. A wider ruling can remove the requirements for insurance companies to guarantee the services recommended by USPSTF without the cost of costs. Very extensive decisions can destroy all preventive service obligations according to Affordable Care Act. Alternatively, the court may not be completely ruled on the plaintiff or decides the case as a procedural basis.
The scope of preventive health insurance has been proven to be a valuable benefit that saves life and improves health. Regardless of the Supreme Court ruling, there is a strong reason why employers must maintain the guarantee of preventive services without cost sharing such as deductions and cavity.
Recommendations are the three federal panels that determine the service without the share of patient costs.
- that Advisory Committee on vaccination practices (ACIP) recommends childhood and adult vaccines. Determination of Earth and the 5th Travel Court No ~ It affects these recommendations that are approved by the Director of Disease Control and Prevention Center.
- that Health resource and service management (HRSA) recommends women and child health services, including screening, testing, prenatal treatment, contraceptives and health checkups. District Court and 5th Courtial court ruling No ~ It affects these recommendations that the Minister of Health and Welfare must approve.
- that USPSTF Selection recommendations to detect cancer and other diseases and drugs for preventing diseases such as metastatic breast cancer and HIV. Affordable Care Act does not require these recommendations to partially approve the federal appointment. USPSTF isolated from political interference. The District Court and the Fifth Court ruling affect the recommended recommendations after the ACA was enacted.
In the health plan sponsored by the ACA-based employer based on this ruling, the prevention services that no more need to be provided without cost sharing will be lung cancer, colon cancer (45-49 years) and hepatitis C, heart disease prevention, breast cancer recurrence and HIV transmission.
Employers are considered some considerations considering the future insurance coverage for preventive treatment.
1. Providing prevention treatment without cost sharing can prevent future chronic diseases or death.
Most of these preventive services are low, but Removing cost sharing usually increases the use of medical services.. This is the basic principle of value -based insurance design, while the highest value service recommends low cost sharing, while low value services are higher in cost sharing. The use of preventive services has increased due to the removal of cost sharing, improving health results. At least one -third of the respondents in 2023 inspection If insurance was not covered, he said he would give up prevention services. Reporting prevention treatment, which does not cost the copayment, also directly consists of public health policy support for protecting Americans’ health and fighting chronic diseases.
It is especially important to remove cost sharing for preventive services. High deductions (HDHPS). These members must pay the total cost of all medical care before meeting the annual deduction. It is an average aggregation for people with deductions. HDHP’s deduction is $ 4,991 In 2024, Affordable Care Act allows the maximum family planning deduction. $ 18,400 2025.
2. It is inexpensive to provide a range of applications without the cost of most of these services.
The costs that provide most of the preventive treatment in this ruling are as follows. Pretty humble. Some of these services, such as drug use tests or mental health services, are provided during the existing office visit, so there is little cost. Each USPSTF recommended blood test is usually less than $ 50. Colonum endoscopy is expensive, but the cost of giving up the expenses of 45-49 years is recommended in 10 years, so this individual may have been inspected by the 50-year-old colonoscopy.
3. Prevention services are used by many people and coverage is popular.
for 100 million people Prevention services used for personal insurance (60%of the insured) in 2018; The use of preventive services was the most common for women and children. Almost 1/4 (23%) is a prevention service and chronic disease management The most important service is applied By health plan. 62 % of respondents in 2019 KFF survey It is very important to ask for insurance to cover the total cost of preventive treatment. This is one of the highest levels of ACA in the political spectrum.
4. The latest scientific evidence is the most beneficial guide for design planning.
The Braidwood District Court ruling may require employers to provide insurance coverage without the cost of the recent evidence, except for the recent evidence, according to the 2010 or previous guidelines. This will reduce the total interests of preventive treatment. For example, colon cancer rates are rising from under 50 years of age, so if you move to 45 years old to select colon cancer, you will save additional life at an additional cost. Similarly, the actual experience of the prevention of heart disease after 2010 has announced that it will provide statin drugs without sharing risks to people over 40 years of age, according to USPSTF’s recommendations.
If you design a medical benefit guarantee without considering the evidence announced after 2010, you can provide too much treatment in some cases. for example, 2003 USPSTF Guidelines Recommended annual cervical cancer screening, screening every three to five years, I understand that most women are at risk. on the other side 2007 USPSTF Guidelines It is better to select sexually active women only for chlamydia, not gonorrhea, which is more common and the same urine sample. Benefits should be based on the latest evidence.
5. The main requirement for preventive treatment insurance applies only to the completely guaranteed state regulatory plan.
15 states The state regulatory health insurance plan generally includes coverage of prevention services that reflect ACA. This law does not apply Nearly two -thirds self -funding plan People with health insurance sponsored by employers. If you maintain the entire guarantee for preventive treatment, you can preserve equality in a completely guaranteed and self -insurance health plan when the employer offers both.
6. The internal profit service regulations are tax -supported health savings accounts that allow pre -deductions for prevention treatment without sharing costs for health plans.
that Internal revenue code Health plans sponsored by employers are allowed to provide preventive treatment for members of a deductible health plan without having to dangerous the tax support in the health care account. This rule If it does not change as a result of the braidwood Therefore, the possibility of tax deduction of the health savings account should not have a negative impact by continuing to provide insurance applications without the cost of the copayment of these services. If the Braidwood decision is supported, internal profit service is requested to solve this problem more officially.
Over the past decade, employees have been expected to provide all insurance coverage for preventive treatment by employers. Even if this scope of insurance is no longer required, it shows the commitment to employee welfare. Staff I really care about health and welfare It is less likely to find new jobs, reduces the absence and increases productivity.
The Supreme Court, which is expected in late spring or early summer, can inject uncertainty into the design of the health plan sponsored by the employer. The Company pays the right price to provide insurance coverage without sharing the cost of preventive services recommended by the three evidence -based federal panels. By continuing to provide these insurance coverage, employers will improve member health and show clear support for employees.
Jeff Levin-ScherzMD and MBA are executive directors and population health leaders of WTW’s North American health and benefits. He is an assistant professor at Harvard Medical School and a Harvard Cha Aerial Health School.
