Prevention benefits at risk with an Obamacare repeal
Skip to main content
MDHC_Logotype_white
Subscribe
  • My Account
  • Login
  • Subscribe
  • News
    • This Week's News
    • COVID-19
    • Providers
    • Insurance
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • People
    • Regional News
    • Digital Edition
    • Barbers, artists help defy vaccine myths for people of color
      US opens more distance in worldwide race against coronavirus
      Private equity's estimated healthcare spending halved in first quarter
      UnitedHealthcare sees Q1 profits rise and other key earnings takeaways
    • Barbers, artists help defy vaccine myths for people of color
      US opens more distance in worldwide race against coronavirus
      FCC to open next round of COVID-19 telehealth program applications
      Virus is 'runaway train' at Michigan hospital system
    • Some healthcare associations moving full steam ahead with conferences starting in summer
      COVID hospitalizations in Michigan top fall surge; Beaumont seeing nurse 'burnout'
      Calls mount for Biden to track U.S. healthcare worker deaths from COVID
      Front-line workers want more assistance after a year of COVID-19
    • UnitedHealthcare sees Q1 profits rise and other key earnings takeaways
      California re-opens enrollment for health insurance coverage
      Insurers are partnering to offload the costs of kidney failure patients
      Cigna and Oscar expand their small business partnership
    • J&J vaccine pause a minor blip, but efforts must press on, experts say
      Effort to keep Arkansas Medicaid plan falls short in state Legislature
      A year into pandemic, federal officials design new mask guidelines to better protect more workers
      Long-term care providers concerned by effects of J&J COVID-19 vaccine pause
    • Private equity's estimated healthcare spending halved in first quarter
      UH reports $54.7M operating income for 2020 despite significant COVID-related costs
      CMS issues new guidance to enforce price transparency rule
      Massachusetts to crack down on highest-cost hospitals, insurers
    • FCC to open next round of COVID-19 telehealth program applications
      CHIME, HLTH to host joint spring conference next year
      Anthem, Blackstone launch new joint venture
      Healthcare data breaches
    • Michigan expands antibody treatment to cut hospitalizations
      J&J vaccine pause a minor blip, but efforts must press on, experts say
      A year into pandemic, federal officials design new mask guidelines to better protect more workers
      FDA pauses enforcement of in-person dispensing requirement for abortion pill
    • Oscar names new virtual-first care division president
      Redfield joins Big Ass Fans, which promotes controversial COVID-killing technology
      Next Up Podcast: Modern Healthcare's editor Aurora Aguilar talks new content direction
      Novant Health adds chief payor performance officer
    • Midwest
    • Northeast
    • South
    • West
  • Insights
    • ACA 10 Years After
    • Best Practices
    • Special Reports
    • Innovations
    • The Affordable Care Act after 10 years
    • A close-up of a woman receiving a COVID-19 vaccine.
      Providers in underserved communities work toward equitable vaccine distribution
      Josh Bradshaw
      How one rural Illinois county vaccinated 84% of its senior citizens by early March
      Dr. John Fischer
      Patient-reported outcomes tool for hernia surgery helps physicians improve care
      New care model helps primary-care practices treat obesity
    • Jennifer Pannone and her daughter Victoria.
      Mental health access for children needs attention
      A family photo of the the Hangens.
      Stressing the already burdened pediatric behavioral health system
      What's next for on-demand telehealth companies?
      A map of the U.S. with images of the coronavirus.
      The digital divide becomes a new social determinant of health
    • Ryan McGinnis
      Finding efficiencies in the OR using tech
      Dr. Daniel Hall
      UPMC pilots machine learning, telehealth to inform patient transfers
      A woman being recorded using her inhaler on a smartphone.
      Digital check-ins, connected inhalers help control asthma
      A phone screen showing the question, "Mary we hope this information was helpful and we'd like to keep guiding you. Are you interested in knowing when it's your turn to receive the vaccine?"
      Chatbots, texting campaigns help manage influx of COVID vax questions
  • Transformation
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • Mayo Clinic launches two tech companies
      Diabetes patients at high risk for COVID-19 are managing conditions more effectively
      Nearly 1 in 5 Americans skipped care due to cost last year
      COVID-19 long-haulers need holistic treatment, providers say
    • Amazon gives out $12M under next phase of AWS diagnostics development initiative
      Malpractice premiums peak in 2020, AMA survey shows
      A rendering of a cancer research institute at the University of Southern California that will include 5G.
      Healthcare providers determine how to best use ultrafast 5G
      Two-thirds of largest hospitals aren't complying with price transparency rule
    • Addressing long-standing barriers needed for mental and physical health integration
      A close-up of a woman receiving a COVID-19 vaccine.
      Providers in underserved communities work toward equitable vaccine distribution
      The waiting room of a Kaiser Permanente clinic at a Target location.
      Health systems revamp their approach to retail clinics
      Josh Bradshaw
      How one rural Illinois county vaccinated 84% of its senior citizens by early March
    • When money talks. Why cash pay is becoming more popular
      CMS wants to bump pay for hospices, SNFs next year
      CMMI pauses new Direct Contracting model applications
      CMS wants to boost payments over 2% for inpatient rehab, psych facilities
  • Data/Lists
    • Rankings/Lists
    • Interactive Databases
    • Data Points
    • Health Systems Financials
      Executive Compensation
      Physician Compensation
  • Op-Ed
    • Bold Moves
    • Breaking Bias
    • Commentaries
    • Letters
    • Vital Signs Blog
    • From the Editor
    • Dr. Alan Kaplan
      The risks, rewards of taking organizations 'where they haven’t gone before'
      Wellstar CEO calls adapting for the pandemic her bold move
      Howard P. Kern
      Recognizing the value of telehealth in its infancy
      Dr. Stephen Markovich
      A bold move helped take him from family doctor to OhioHealth CEO
    • Drs. Hal Paz and Joshua J. Joseph
      Mobilized to fight the COVID crisis: a blueprint for community and academic partnerships
      Dr. Stephen Markovich
      Making sure we're aligned along the path to achieving inclusion
      Barry Ostrowsky
      Ending racism is a journey taken together; the starting point must be now
      Laura Lee Hall and Gary Puckrein
      Increased flu vaccination has never been more important for communities of color
    • Five lessons for securing our children's future
      We're losing engaged providers, and healthcare will pay the price
      Dr. Chris DeRienzo
      How COVID-19 broke health systems and made them stronger
      Bonnie Castillo and John Welton
      Dueling opinions: The role of mandated nurse staffing ratios
    • Letters: Eliminating bias in healthcare needs to be ‘deliberate and organic’
      Letters: Maybe dropping out of ACOs is a good thing for patients
      Letters: White House and Congress share blame for lack of national COVID strategy
      Letters: VA making strides to improve state veterans home inspections
    • Sponsored Content Provided By Optum
      How blockchain could ease frustration with the payment process
      Sponsored Content Provided By Optum
      Three steps to better data-sharing for payer and provider CIOs
      Sponsored Content Provided By Optum
      Reduce total cost of care: 6 reasons why providers and payers should tackle the challenge together
      Sponsored Content Provided By Optum
      Why CIOs went from back-office operators to mission-critical innovators
  • Awards
    • Award Programs
    • Nominate
    • Previous Award Programs
    • Other Award Programs
    • Nominations Closed - 50 Most Influential Clinical Executives
      Nominations Open - Top 25 Innovators
      Nominations Open May 24 - Top 25 Emerging Leaders
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • Best Places to Work in Healthcare
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top 25 Emerging Leaders
    • Top 25 Innovators
    • Minorities in Healthcare
      • - Luminaries
      • - Top 25 Minority Leaders
      • - Minorities to Watch
    • Women in Healthcare
      • - Luminaries
      • - Top 25 Women Leaders
      • - Women to Watch
    • Excellence in Nursing Awards
    • Design Awards
    • Top 25 COOs in Healthcare
    • 100 Top Hospitals
    • ACHE Awards
  • Events
    • Conferences
    • Galas
    • Webinars
    • COVID-19 Event Tracker
    • emburse certify modern healthcare custom media webinar logo lockup
      Sponsored Content Provided By Emburse
      Webinar: Making it easy to manage costs
      virtualmed staff modern healthcare custom media logo lockup
      Sponsored Content Provided By VirtualMed Staff
      Webinar: Best practices for creating a successful telepsychiatry program
      telehealth visit man touching neck while speaking to doctor on computer
      Sponsored Content Provided By Accumen
      Webinar: How telehealth has evolved into a standard of care
      modern healthcare custom media and trimedx custom webinar logo lockup
      Sponsored Content Provided By TRIMEDX
      Webinar: Bridging the gap between clinicians and administration to improve capital equipment planning
    • Women Leaders in Healthcare Conference
    • Social Determinants of Health Symposium
    • Healthcare Transformation Summit
    • Leadership Symposium
    • Virtual Briefings
      • - Hospital of the Future
      • - Mental Health
      • - Patient Safety & Quality
      • - Strategic Marketing
      • - Virtual Health
      • - Workplace of the Future
    • Best Places to Work Awards Gala
    • Health Care Hall of Fame Gala
    • Top 25 Minority Leaders Gala
    • Top 25 Women Leaders Gala
  • Listen
    • Podcast - Next Up
    • Podcast - Beyond the Byline
    • Sponsored Podcast - Healthcare Insider
    • Video Series - The Check Up
    • Sponsored Video Series - One on One
    • Next Up Podcast: Modern Healthcare's editor Aurora Aguilar talks new content direction
      Dr. Chris DeRienzo
      Next Up Podcast: Building team spirit in the wake of COVID-19
      Mikelle Moore
      Next Up Podcast: Mikelle Moore on recognizing all hospital workers during the pandemic
      Empty boardroom
      Next Up Podcast: What's going to happen tomorrow? Succession planning during emergencies
    • Beyond the Byline: Kids' unchecked mental health needs pose long-term consequences
      Beyond the Byline: How COVID-19 has impacted hospital finances
      An older man sitting on a hospital bed with his back toward the camera.
      Beyond the Byline: Upcoding could explain why hospitals are increasingly billing for the most complex treatment
      Beyond the Byline: Insurers are betting on virtual-first plans as COVID-19 shifts care pathways
    • James garvert neustar healthcare insider podcast image
      Building on basics
      Healthcare Insider Podcast Episode Art - Premier
      Why Roger Weems and other consultants are leaving the big firms to join Premier
      James garvert neustar healthcare insider podcast image
      Outreach during COVID-19
      ann barnes healthcare insider podcast image
      Leading with intention to promote diversity and inclusion
    • The Check Up: Dr. James E.K. Hildreth
      The Check Up: Dr. James E.K. Hildreth of Meharry Medical College
      The Check Up: Matt Eyles
      The Check Up: Matt Eyles of AHIP
      The Check Up: Dr. Tom Shanley
      The Check Up: Dr. Tom Shanley of Lurie Children’s Hospital of Chicago
      The Check Up: Dr. Harold Paz
      The Check Up: Dr. Harold Paz of Wexner Medical Center at Ohio State University
    • ivana naeymi-rad one on one intelligent medical objects
      Video: Ivana Naeymi Rad of Intelligent Medical Objects
  • MORE +
    • Advertise
    • Media Kit
    • Newsletters
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
Breadcrumb
  1. Home
  2. Government
January 28, 2017 12:00 AM

Prevention benefits at risk with an Obamacare repeal

Harris Meyer
  • Tweet
  • Share
  • Share
  • Email
  • More
    Print

    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 co-authored 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 purchased 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. “Out-of-pocket medical costs compete against people's other living costs. We should allow people to make those tradeoffs.”

    MH TAKEAWAYS

    ACA repeal puts free cancer screenings and prevention benefits for seniors and many privately insured patients at risk, although it might take a prolonged rulemaking process to make it happen.

    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 high-deductible 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.

    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 first-dollar 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 Administration-approved forms of contraception; breast cancer screening and follow-up 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.

    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    More than a dozen states to open vaccines to all adults
    More than a dozen states to open vaccines to all adults
    Becerra visits Nevada, stumps for pandemic aid and Obamacare
    Becerra visits Nevada, stumps for pandemic aid and Obamacare
    Sponsored Content
    Get Newsletters

    Sign up for enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today
    MH Magazine Cover

    MH magazine offers content that sheds light on healthcare leaders’ complex choices and touch points—from strategy, governance, leadership development and finance to operations, clinical care, and marketing.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS
    • Instagram

    Our Mission

    Modern Healthcare empowers industry leaders to succeed by providing unbiased reporting of the news, insights, analysis and data.

    MDHC_Logotype_white
    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Advertise with Us
    • Ad Choices Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    • Privacy Request
    Modern Healthcare
    Copyright © 1996-2021. Crain Communications, Inc. All Rights Reserved.
    • News
      • This Week's News
      • COVID-19
      • Providers
      • Insurance
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition
    • Insights
      • ACA 10 Years After
      • Best Practices
      • Special Reports
      • Innovations
    • Transformation
      • Patients
      • Operations
      • Care Delivery
      • Payment
    • Data/Lists
      • Rankings/Lists
      • Interactive Databases
      • Data Points
    • Op-Ed
      • Bold Moves
      • Breaking Bias
      • Commentaries
      • Letters
      • Vital Signs Blog
      • From the Editor
    • Awards
      • Award Programs
        • 100 Most Influential People
        • 50 Most Influential Clinical Executives
        • Best Places to Work in Healthcare
        • Health Care Hall of Fame
        • Healthcare Marketing Impact Awards
        • Top 25 Emerging Leaders
        • Top 25 Innovators
        • Minorities in Healthcare
          • - Luminaries
          • - Top 25 Minority Leaders
          • - Minorities to Watch
        • Women in Healthcare
          • - Luminaries
          • - Top 25 Women Leaders
          • - Women to Watch
      • Nominate
      • Previous Award Programs
        • Excellence in Nursing Awards
        • Design Awards
        • Top 25 COOs in Healthcare
      • Other Award Programs
        • 100 Top Hospitals
        • ACHE Awards
    • Events
      • Conferences
        • Women Leaders in Healthcare Conference
        • Social Determinants of Health Symposium
        • Healthcare Transformation Summit
        • Leadership Symposium
        • Virtual Briefings
          • - Hospital of the Future
          • - Mental Health
          • - Patient Safety & Quality
          • - Strategic Marketing
          • - Virtual Health
          • - Workplace of the Future
      • Galas
        • Best Places to Work Awards Gala
        • Health Care Hall of Fame Gala
        • Top 25 Minority Leaders Gala
        • Top 25 Women Leaders Gala
      • Webinars
      • COVID-19 Event Tracker
    • Listen
      • Podcast - Next Up
      • Podcast - Beyond the Byline
      • Sponsored Podcast - Healthcare Insider
      • Video Series - The Check Up
      • Sponsored Video Series - One on One
    • MORE +
      • Advertise
      • Media Kit
      • Newsletters
      • Jobs
      • People on the Move
      • Reprints & Licensing