The U.S. Supreme Court in Washington. Photo: Diego M. Radzinschi/ALM
The U.S. Supreme Court could kill part or all of the Affordable Care Act preventive services coverage requirements this year, but laws in many states should keep something like the current rules in place for employers with fully insured group health coverage.
About 15 states already have local versions of the ACA preventive services package requirements codified into state laws, and others could do the same, according to Sabrina Corlette, the co-director of Georgetown University's Center on Health Insurance Reforms.
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States can also keep ACA preventive services benefits requirements in place by including the benefits in a state's list of "essential health benefits," or standard major medical insurance benefits package, Corlette said Wednesday in Indianapolis, during a Health Insurance and Managed Care Committee session at the National Association of Insurance Commissioners' spring national meeting.
State EHB rules should require issuers to stick with public health experts' recommendations about which plan participants should get what types of care and how often, Corlette said, according to a copy of her presentation slidedeck included in a meeting document packet.
Corlette said state insurance regulators can ease the effects of any sudden preventive services benefits changes by helping consumers and employers understand what's happening.
"Require advance notice for consumers and policyholders of benefit design changes," Corlette said.
What it means: Corlette's presentation could have a concrete effect on how states respond to any Supreme Court ruling against the current ACA preventive services requirements. She has been briefing federal and state policymakers on ACA issues for years, and her work has influenced how they've designed and implemented ACA rules and programs.
Braidwood v. Becerra: The NAIC health committee included Corlette's presentation on its meeting agenda because of news that the Supreme Court will hear oral arguments on a major ACA preventive services package case, Braidwood vs. Becerra, April 21.
The ACA now requires both health insurers and self-insured employer health plans to cover the services included in the ACA preventive services package without imposing deductibles, copayments or other out-of-pocket costs on the insureds.
The package includes services such as checkups, vaccinations and cancer screenings.
The employer plaintiffs have argued that the federal government has created an unconstitutional process for creating at least part of the ACA preventive services benefits package, by delegating responsibility for choosing some of the covered benefits to advisory boards made up of health care experts who are not appointed by the president or confirmed by the Senate.
A district court judge and a three-judge panel at the 5th U.S. Circuit Court of Appeals sided with the employer plaintiffs.
The administration of former President Joe Biden defended the right of the U.S. Department of Health and Human Services to keep the current system for creating the ACA preventive services benefits package. Under President Donald Trump, HHS has continued to defend the current preventive services coverage strategy.
Preventive services benefits after Braidwood: If the Supreme Court sides with the employers who filed the case, any state laws could keep the same or similar coverage requirements in place for employers with fully insured coverage, but the state rules would be preempted by the Employee Retirement Income Security Act.
Related: Supreme Court to hear case challenging no-cost screening requirements
Kevin Conroy, the chief executive officer of Exact Sciences, a cancer screening test firm, recently told securities analysts that he thinks most commercial health insurers would keep most of their current preventive services benefits in place no matter how the Supreme Court rules, to improve participants' health and maintain coverage quality ratings.Employers with self-insured plans could adopt a similar strategy.
One headwind could be a lack of studies showing what kind of an effect the current rules have had on patients' health or the overall cost of care. Up till now, partly because the requirements are still new and any health effects may take decades to show up, typical studies focused on the impact of the preventive services requirements on the odds that patients will get the recommended screenings, not on health or mortality indicators.
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Allison Bell
Allison Bell, a senior reporter at ThinkAdvisor and BenefitsPRO, previously was an associate editor at National Underwriter Life & Health. She has a bachelor's degree in economics from Washington University in St. Louis and a master's degree in journalism from the Medill School of Journalism at Northwestern University. She can be reached through X at @Think_Allison.
