Preven­tion ben­e­fits at risk

Modern Healthcare - - NEWS - By Har­ris Meyer

The Af­ford­able Care Act ex­tended 100% cov­er­age for a range of pre­ven­tive health­care services, in­clud­ing some types of cancer screen­ing, to se­niors on Medi­care. That first-dol­lar cov­er­age likely saved lives by in­creas­ing di­ag­noses of early-stage col­orec­tal cancer by 8% among Medi­care ben­e­fi­cia­ries dur­ing the first three years it was in ef­fect, a new study in Health Af­fairs re­ported.

Now ex­perts fear Repub­li­cans will elim­i­nate the law’s man­date for full cov­er­age of rec­om­mended pre­ven­tive services in tax­payer-fi­nanced and em­ployer-based health plans. The GOP pro­pos­als also would erase the re­quire­ment that in­di­vid­ual plans of­fer min­i­mum es­sen­tial ben­e­fits in 10 cat­e­gories, in­clud­ing men­tal health and sub­stance abuse, ma­ter­nity care and pre­scrip­tion drugs.

Even with­out a re­place­ment plan, some pre­dict the Trump ad­min­is­tra­tion may move quickly to ease cov­er­age rules. The pres­i­dent’s re­cent ex­ec­u­tive or­der in­structed fed­eral agen­cies to roll back the ACA.

That could have lethal con­se­quences for some se­niors. “We found that about 8,400 peo­ple had their col­orec­tal cancer de­tected at an early stage due to the first-dol­lar cov­er­age, and their chance for five-year sur­vival is much higher,” said Nengliang Yao, an as­sis­tant pro­fes­sor of pub­lic health at the Univer­sity of Vir­ginia, who coau­thored the Health Af­fairs study. “That’s a lot of lives. I hope (the Repub­li­cans) will keep and strengthen preven­tion-re­lated services.”

GOP pro­pos­als, in­clud­ing those re­leased by House Speaker Paul Ryan and HHS sec­re­tary-nom­i­nee Dr. Tom Price, would en­cour­age in­sur­ers to of­fer cheaper, high-de­ductible plans by elim­i­nat­ing var­i­ous ACA man­dates, in­clud­ing cov­er­age of pre­ven­tive services. The the­ory is that con­sumers could fun­nel sav­ings from lower pre­mi­ums into tax-shel­tered health sav­ings ac­counts to pay for vol­un­tar­ily pur- chased cancer screen­ing and other pre­ven­tive services.

The GOP re­place­ment plan “won’t say you can’t or shouldn’t have pre­ven­tive cov­er­age, but it won’t mi­cro­man­age it,” said Tom Miller, a con­ser­va­tive health pol­icy ex­pert at the Amer­i­can En­ter­prise In­sti­tute. “Outof-pocket med­i­cal costs com­pete against peo­ple’s other liv­ing costs. We should al­low peo­ple to make

those trade­offs.”

With­out a ben­e­fit man­date, pri­vate in­sur­ers would be free to limit preven­tion cov­er­age to plans with higher pre­mi­ums, said J.B. Sil­vers, a pro­fes­sor of health­care fi­nance at Case Western Re­serve Univer­sity and for­mer health plan CEO.

Health­care providers and pa­tient ad­vo­cacy groups fear that would lead many pa­tients of mod­est means to skip cancer screen­ings and other pre­ven­tive services, as many did in pre-ACA days. A post-elec­tion sur­vey of pri­mary-care physi­cians pub­lished in the New Eng­land Jour­nal of Medicine found that only 29% sup­ported ex­pand­ing the use of high­d­e­ductible plans.

“When you put in cost bar­ri­ers, es­pe­cially for col­orec­tal cancer screen­ing, there’s a lot of re­luc­tance among pa­tients to get the screen­ing,” said Caro­line Pow­ers, di­rec­tor of fed­eral re­la­tions for the Amer­i­can Cancer So­ci­ety’s Cancer Ac­tion Net­work. She noted that a colonoscopy could cost pa­tients up to $1,000 out of pocket with­out the first-dol­lar cov­er­age man­date.

She and other ex­perts doubt that HSAs would make much dif­fer­ence. “Pa­tients with chronic ill­nesses be­come very wary about spend­ing their scarce dol­lars on preven­tion,” said Dr. Cary Gross, an in­ternist and pro­fes­sor at the Yale School of Medicine.

“If one were try­ing to get rid of the min­i­mum es­sen­tial ben­e­fits, it wouldn’t make sense to try to change them two years from now.” DONNA PALANKER Health pol­icy ex­pert at Ge­orge­town Univer­sity

Some con­ser­va­tives and in­sur­ers hope the Trump ad­min­is­tra­tion will pare down the ACA’s re­quired ben­e­fits in time to re­duce pre­mi­ums for in­di­vid­ual-mar­ket plans sold for 2018. But that prob­a­bly can’t be done through swift ad­min­is­tra­tive ac­tion, ex­perts say.

Congress pre­scribed the es­sen­tial ben­e­fits pack­age in the ACA, which was im­ple­mented through for­mal rule-mak­ing. Usu­ally, it takes an­other rule to re­peal a rule, which can take months. Con­ser­va­tive le­gal schol­ars are hop­ing the Con­gres­sional Re­view Act may pro­vide a loop­hole for skirt­ing that process.

In­sur­ers need to know the new ben­e­fits rules be­fore fil­ing their pro­posed 2018 ACA plan of­fer­ings and rates this spring. So the ear­li­est the ad­min­is­tra­tion likely could im­ple­ment slimmed-down ben­e­fits re­quire­ments would be for the 2019 plan year.

Repub­li­cans are hop­ing to pass a full leg­isla­tive pack­age to re­place the ACA long be­fore then.

“If one were try­ing to get rid of the min­i­mum es­sen­tial ben­e­fits, it wouldn’t make sense to try to change them two years from now,” said Da­nia Palanker, a health pol­icy ex­pert at Ge­orge­town Univer­sity.

The Trump ad­min­is­tra­tion may have an easier time rolling back women’s services, par­tic­u­lar con­tra­cep­tion. That’s be­cause those first­dol­lar ben­e­fits were es­tab­lished through guide­lines up­dated in De­cem­ber by the Health Re­sources and Services Ad­min­is­tra­tion, based on rec­om­men­da­tions from a med­i­cal task force. They in­clude all 18 Food and Drug Ad­min­is­tra­tionap­proved forms of con­tra­cep­tion; breast cancer screen­ing and fol­lowup test­ing; breast feed­ing sup­port and sup­plies; and test­ing for the hu­man pa­pil­lo­mavirus.

The ACA’s con­tra­cep­tion cov­er­age has been re­peat­edly chal­lenged by re­li­gious con­ser­va­tives. Price re­cently said at his con­fir­ma­tion hear­ing that “women (should) be able to pur­chase the kind of con­tra­cep­tion they de­sire.” Delist­ing birth con­trol as a cov­ered ser­vice may not re­quire go­ing through for­mal rule-mak­ing, Palanker said.

The AEI’s Miller ques­tions the value of many pre­ven­tive services, and thinks they should be dereg­u­lated. But he also wor­ries about turn­ing back those de­ci­sions to the states, where provider and pa­tient groups have lever­age. “Pol­i­tics at the state level has tended to in­crease those re­quired ben­e­fits,” he noted.

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.