by Joseph Williams
A group of public health experts warned on Thursday that a Supreme Court case set for arguments next week could lead to the end of a central, highly popular component of the Affordable Care Act — one that has improved a range of health outcomes for Black Americans.
The case hasn’t received widespread notice, but Braidwood Management v. Becerra has the potential to cause millions of Americans to avoid ACA-mandated free screening and services for preventable diseases, like diabetes or colon cancer. If that happens, the experts said, things will almost certainly get worse in Black communities.
And Black women — who disproportionately rely on free prevention services — could be at particularly high risk.
“Expect to see more heart disease, more lung cancer, more kidney disease in communities of color,” Dr. Georges Benjamin, executive director of the American Public Health Association, said after a joint press briefing Thursday. If low-income patients are forced to hand over a copay for cancer screening, he says, “people will receive less care, later in the course of their disease, at a higher cost and a higher death rate.”
In turn, “the Black-white death gap, the Hispanic-white death gap will increase in those communities,” he says.
Ideology Jeopardizes Public Health Progress
At issue is a very narrow provision in the ACA that allows the U.S. Preventive Services Task Force, an independent entity convened by the federal government, to determine which preventive services private insurance policies must cover without cost-sharing. Braidwood, a private management company run by conservative Christians, objects to a task force recommendation that birth control, the HPV vaccination and devices and PrEP — a drug which prevents transmission of HIV — should be considered preventive treatments.
In court filings, Braidwood contends that requirements to include those provisions “encourage homosexual behavior, intravenous drug use, and sexual activity outside of marriage between one man and one woman,” in violation of their religious beliefs. They want the court to rule that the task force’s role in determining preventive care is unconstitutional, a ruling that would effectively hollow out that part of the Affordable Care Act.
In the press call, Benjamin, along with Kathy Hempstead, a senior policy officer with the Robert Wood Johnson Foundation, and Dorianne Mason, director of health equity for the National Women’s Law Center, laid out what’s at stake in the case. All three agreed that people are less likely to pay for services they now get for free — even if those services are potentially life-saving. (Disclosure: The Robert Wood Johnson Foundation supports Word In Black’s health journalism.)
“We know that since the preventive services requirement has occurred, millions more women have received preventive care,” Mason says. “That means cancer screenings are leading to early stage interventions, higher depression screenings have led to improvement of mental health symptoms. We know that contraception has also decreased unwanted pregnancies.”
For insurers, early screenings and preventive care have reduced the costs they would have incurred down the road, says Mason: “It’s been a win-win, including $26 billion in annual savings from identifying cancer early and $19 billion saved annually from contraception.”
Preventive Care Is an Equity and Justice Issue
Still, “It’s important to note that access to preventive care is also a gender and racial justice issue and key to achieving health equity,” she says. “Data show that there have been larger increases in preventive services uptake among women of color compared to white women since the Affordable Care Act’s passage, and racial and ethnic health disparities have narrowed.”
That includes a narrowing of the black-white gap among women in rates of heart disease, coronary disease, and utilization of mammograms to detect signs of breast cancer, Mason says.
Benjamin pointed out that, if free preventive care disappears, low-income communities will be affected the most.
“If you don’t have the 20 bucks to put down as a copayment, you’re less likely to get checked for lung cancer or colorectal cancer,” he says. The healthcare system, he says, will revert from one in which prevention is key to one that depends on treating diseases that are already here. Insurers will increase costs and revert to requiring copays [for currently free treatment], and consumers will seek less care.”
The problem, Benjamin says, is ideology is getting in the way of sound public health policy.
“It’s a shame they want to take away this service from millions of Americans,” he says, “based on this small number of people based on religious or ideological grounds.”
Source: Seattle Medium
