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Supreme Court Upholds Key Obamacare Measure On Preventive Care
The U.S. Supreme Court Chip Somodevilla/Getty Images hide caption
toggle caption Chip Somodevilla/Getty ImagesThe Supreme Court on Friday upheld a key provision of the Affordable Care Act, ensuring, at least for now, that some 150 million people will continue getting many free, preventive services under the act.
The vote was 6-3, with Chief Justice John Roberts, and Justices Amy Coney Barrett and Brett Kavanaugh joining the court's three liberal justices in the majority.
Siding with the government on Friday, the court upheld the Affordable Care Act, allowing the U.S. Preventive Services Task Force to continue determining which services will be available free of cost to Americans covered by the Affordable Care Act.
Sponsor MessageAt issue in the case was a lawsuit that sought to undo the preventive care provision by challenging the appointment process for members of a 16-person task force that determines which preventive services are to be provided for free under insurance policies. Two lower courts found that the appointments were unconstitutional, but on Friday, the Supreme Court disagreed.
More Supreme Court decisions from today:
More Supreme Court decisions today:
Writing for the court majority, Justice Kavanaugh said the Department of Health and Human Services has the power to appoint members of the task force.
Law Supreme Court limits nationwide injunctions in birthright citizenship order"Task Force members are supervised and directed by the Secretary, who in turn answers to the President, preserving the chain of command in Article II," Kavanaugh wrote.
The ACA's preventive treatments have benefited millions of people since the health care law went into effect 11 years ago — a sufficiently long time for most people to take the free coverage for granted. Activists argued that if the court ruled for the groups challenging the law, the benefits could disappear.
Friday's case arose when the preventive care task force classified pre-exposure prophylaxis (PrEP) drugs as essential to preventing HIV. Preventive PrEP coverage under the ACA includes not only HIV testing and medication, but also clinic visits and lab testing without added cost-sharing. Without ACA coverage, PrEP care would be astronomically expensive for most Americans.
The suit was brought by individuals and businesses with religious objections to the PrEP mandate—they claimed that providing PrEP coverage encourages "sexual behaviors and drug use" antithetical to their Christian beliefs.
Braidwood Management, the case's named plaintiff, is led by Republican mega donor Steven Hotze who has referred to members of the LGBTQ+ community at different times as "morally degenerate," "satanic," and "termites." Hotze, has challenged the ACA in at least two other federal lawsuits.
The court's decision on preventive care likely will protect other existing preventive services under ACA, including treatment for blood pressure screenings, as well as birth control, breast and lung cancer screenings, immunizations, and more.
Prior to the court's decision on Friday, proponents of the ACA's existing preventive coverage had worried that without it, the financial burden of out-of-pocket expenses for these services would have discouraged people from getting care to prevent or detect disease at an early and treatable stage.
"I cannot think of another health policy that impacts more Americans than the preventive services provision," said Dr. Mark Fendrick, a professor of medicine and public health at the University of Michigan.
Two lower courts in Texas found that the government violated the Appointments Clause of the Constitution because its task force members were appointed not by the president, but by the secretary of Health & Human Services.
Health What does a 2nd Trump term mean for the Affordable Care Act?The Supreme Court, however, disagreed, declaring that the task force was not composed of principal officers who must be appointed by the president and confirmed by the Senate. Rather, the court said, the advisory panel is composed of "inferior officers," who may be appointed by a department head if that power is designated by Congress. Moreover, as the government pointed out in its briefs, the task force members are directly supervised by the HHS secretary, and members can be terminated at will.
United Healthcare To Require Pre-authorization For Some Colonoscopies - USA TODAY
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Understanding The Role Of Ambulatory Surgery Centers In Preventive Cancer Care - Forbes
CEO, Atlas Surgical Group, a private ASC group in the U.S., Author of "Success in Ambulatory Surgery Centers: The Next Gold Rush."
gettyLouise Fitzgerald once said, "What is lack of prevention but denial that there is anything to be prevented." I think that sums up the biggest ailment that we as a nation face. Many cancers are preventable, and screening tests can help in this process: Pap smears, colonoscopies, mammograms and on and on. We continue to pour money into medical research, drug formulations, cutting-edge new surgeries when the solution is right there: prevention of illness. While the topic is broad, purely from a preventive procedure perspective, those of us working in ambulatory surgery centers (ASCs) are uniquely situated to help.
As the CEO of a surgery center franchise, I feel that the game-changer could come from business leaders and CEOs out there. If every leader put preventive healthcare on the agenda for their employees, we could help millions of people every year. Many of the larger institutions are already doing it, but the numbers will come from the small businesses. Offer a dinner coupon if your employee gets a colonoscopy. Cover the copay if they get a mammogram. Offer to cover deductibles for screening tests. I believe altruism itself is the greatest reward in business.
Many employers don't cover the employee insurance premium. Consider taking that off the employee's shoulders in return for having them be proactive at preventative care.
Health Plans And Payments
Surgery centers and other such endeavors do not operate at capacity for many reasons. One of those reasons is that not all preventative evaluations and/or procedures are covered by health plans. What could possibly be a rational explanation for this?
Since much of our medical care is covered (translated, paid for) by third-party payers, and since these payers are a business and not just an altruistic benevolent society, the arithmetic of profit vs. Loss and cost containment enter into the figures—whole decimal points at a time.
Taking care of someone with advanced cancer is usually more expensive than prevention, yet how far prevention will go depends on the actuary tables. When an insurer's data indicates that someone with GERD more than likely won't get esophageal cancer, treating the GERD is inexpensive, but performing a diagnostic endoscopy to rule out precancerous changes is costly to them. So they often push the proverbial tin can down the road, and the patient goes on in life. The sad, salient point here is that the tables treat the patient with GERD as an altogether different person from the person who will go on to experience esophageal cancer: That person has either lost their insurance, moved on to different employment and different insurers, or reached 65 and is now using Medicare. The liability has changed away from the original insurer.
Preventive Screenings And Procedures
ASCs offer preventive screenings and treatments that can help with a variety of issues. Consider the following.
• Colorectal cancer is expensive, both emotionally and nationally. The CDC estimates that 68% of deaths from colorectal cancer could be avoided if all eligible patients got screened. ASCs offer screening colonoscopies with almost assembly-line efficiency, so imagine if this process were utilized to its full potential. The savings to national health expenditures could be financially momentous.
• Unfortunately, colorectal cancer has no monopoly on misery. Acid reflux is associated with one of the leading causes of cancer deaths—esophageal cancer. Some acid reflux patients will go on to develop a malignancy. Yet, it can be treated preventatively with endoscopic treatment for the precursors of esophageal cancers, but I've found it is not covered by the same insurance.
• From the esophagus down—the rest of the story: "EGD," i.E., esophagogastroduodenoscopy—patients can be screened on an outpatient basis for suspicious findings on imaging, follow up on previously identified polyps or ulcers, investigate upper GI bleeding or allow retrieval of biopsies, all in attempt to catch cancer at the earliest possible stage.
• Mammography and breast ultrasound, backed up by ultrasonic-guided biopsies, are all outpatient procedures that can help with the prevention of breast cancer. The reflex sequential nature of the flowsheet has made it cost-effective, e.G., ordering ultrasound on suspicious mammography and then doing biopsies on suspicious ultrasound findings.
• The Pap smear has largely been replaced by HPV genetic identifications, but office colposcopy remains the final disposition on precancerous changes in the uterine cervix. Again, these are all outpatient—even office—procedures.
• Preventative prostate screens using the PSA blood test are not only useful on men with no history of prostate problems, but I've found it can also be useful in following up on those who have had prostate cancer.
What hurts the process is the lack of a true model to promote preventive medicine. We depend on the intelligence and inquisitiveness of common people to know and navigate what is a highly complex field. If I, as a physician, have no knowledge or insight into how complex electrical equipment works, how can I expect a non-medical person to know what terms like dysplasia or carcinogens really mean?
The information provided here is not intended as medical advice, diagnosis or treatment. You should consult with a qualified healthcare provider for advice concerning your specific situation.
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