America's Benefit Specialist May 2023

COURT RULING IMPACTS THE ACA’S PREVENTIVE-CARE BENEFITS

By Scott M. Stevens, RHU Dodge Partners Insurance Omaha, Nebraska sstevens@dodgepartners.com

some pharmaceuticals, has grown from 20-something to over 100 in number. Per the ACA, these services/drugs must be provided to all “non-grandfathered” health insurance plans without any cost-sharing (i.e., copay, deductible, coinsurance), according to established timeframes. Procedures like annual preventive screenings, colonoscopies, mammograms, lung-cancer screen ings and statin drugs are required to be covered at 100%, pro vided care is provided by contracted/preferred providers. The essence of the court case surrounds one of the four sources of healthcare experts that advise the federal gov ernment on recommended preventive-care services. Of the four, one is comprised of volunteer (versus appointed) expert representatives: the United States Preventive Services Task Force (PSTF). The Constitution’s “appointment clause” is violated in this case, according to the court ruling, because of the reliance on volunteer versus appointed representatives. This makes things a bit tricky, as the ruling deems only those preventive services provided by PSTF as unconstitutional.

The Affordable Care Act’s preventive-care mandate has been partially struck down by a federal district judge. On March 30, the ruling made portions of the preventive-care benefit unconstitutional nationwide. The Department of Justice has appealed the decision, so there is likely more to come out of this ruling. Back in December 2017, we published a blog post (https:// tinyurl.com/bdd4jatp) detailing the ACA’s preventive-care benefit, which largely came into effect in 2013. Since that time, the number of covered preventive health services, including

ABSENT THE COURTS DELAYING THIS RULING (I.E., ISSUING A STAY), THE DECISION TAKES EFFECT IMMEDIATELY.

16 ABS | benefitspecialistmagazine.com