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Title of the Blog Post: "A World Without The ACA's Preventive Services Protections: The Impact Of The Braidwood Decision" URL: https://www.healthaffairs.org/content/forefront/world-without-aca-s- preventive-services-protections-impact-i-braidwood-i-decision Change in Implementation Phase of ACA: On March 30, 2023, a federal district court judge issued a ruling that had a profound impact on the implementation of the Affordable Care Act (ACA). The ruling enjoins the government from enforcing ACA requirements that health plans cover and waive cost-sharing for high-value preventive services. This change immediately eliminates the guarantee of benefits Americans have enjoyed for 13 years, potentially causing millions to lose access to no-cost early cancer screenings, mental health assessments, statins for heart disease, PreP to prevent HIV and other critical preventive services. Source and Nature of the Change: The ACA's preventive services mandate changed due to a judicial decision in the case of Braidwood Management v. Becerra. The plaintiffs challenged the constitutionality of the ACA's preventive services provision, arguing that the expert bodies responsible for recommending the services were not constitutionally appointed. The district court partially agreed with this argument, invalidating any services recommended by the U.S. Preventive Services Task Force (USPSTF) since March 23, 2010, the date of the ACA's enactment. This change was brought about by a judicial decision that impacted the law. Impacted Agency and Level of Government: The impact of the Braidwood ruling affects primarily those with private health insurance. It throws Americans who obtain insurance through an employer or directly from an insurer into a state of uncertainty. The change affects private insurance, which various entities regulate depending on the type of insurance. The federal government regulates self-funded employer- sponsored insurance (ESI), while fully insured ESI offered by both large and small employers is subject to state and federal regulation. Individual-market health plans are purchased directly through insurance companies or ACA Marketplaces, with some state laws incorporating the ACA's preventive services benefit. This change impacts the private insurance industry and the individuals relying on it for healthcare services. Expected Impacts: The change has far-reaching implications, and its consequences will depend on the source of insurance. Eliminating the ACA's mandated benefits could lead insurers to discontinue coverage for preventive services or impose cost-sharing. Consumers will likely face uncertainty and confusion regarding their insurance coverage and potential cost-sharing. Providers may also be uncertain about whether their recommended preventive services will remain cost-free, leading to potential delays or avoidance of essential care. Cost-sharing, even in small amounts, is known to deter consumers from using services, mainly high-value preventive services, and could significantly impact public health.
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