Court ruling may jeopardize preventive care

LILO H. STAINTON, HEALTH CARE WRITER | SEPTEMBER 14, 2022

NJ Spotlight News

Millions of New Jerseyans benefit from regular cancer screenings, testing and treatment for diabetes and depression, birth control, vaccinations and other preventive health care procedures, all with no out-of-pocket charge, thanks to a provision in the 2010 federal Affordable Care Act.

Advocates now worry that some of this preventive care may be at risk for 150 million Americans after a federal judge in Texas decided that the way certain services are picked for free coverage is unconstitutional. The case is the latest court challenge to the ACA, or Obamacare, and is grounded in a private company’s religious-based objection to paying for employees to get free medication to prevent HIV spread.

“This latest attack on the Affordable Care Act is discrimination masquerading as religious freedom. Denying access to preventive health care services ignores the basic tenets of public health and would disproportionately harm people of color and the LGBTQ community,” said Brittany Holom-Trundy, senior policy analyst with New Jersey Policy Perspective, a left-leaning research group. “This is like saying cars shouldn’t have seat belts or air bags. There is no policy rationale for this, and people will die as a result.”

Linda Schwimmer, president and CEO of the New Jersey Health Care Quality Institute said preventive care is a critical part of the national health program. “This court is going after one of the pillars of the ACA,” said Schwimmer, who is also an attorney.

But the recent ruling, which is likely to be appealed, could have little real impact on New Jerseyans even if it is upheld, Holom-Trundy and others said. Under Gov. Phil Murphy, a Democrat in his second term, New Jersey has codified in state statute many of the benefits enshrined in the ACA — including free access to preventive care — in case the federal law is dismantled.

NJ, a haven?

“This law makes the Garden State a safe haven for health care access even in light of these attacks on the ACA from other parts of the country,” Holom-Trundy said of the preventive care protections, adopted in 2020. “With this additional buffer to discriminatory challenges to the ACA, we can continue to build New Jersey into a state dedicated to health equity and freedom for all.”

Obamacare has been widely embraced by health care providers and advocates in New Jersey for enabling the state to expand its Medicaid program to reach an additional 500,000 low-income residents. The federal law also gave states new tools and funding to help workers who do not get health insurance through their jobs and Murphy’s team rolled out the state’s version of this online marketplace — called Get Covered NJ — in 2019.

The federal act also required commercial health insurance plans to provide certain basic benefits like coverage for mental health and addiction treatment, pregnancy and childbirth and prescription drugs. The law also forced insurers to cover people with preexisting medical conditions, children up to age 26 on their family plan, and a host of preventive screenings, shots and other services at no out-of-pocket cost.

In his Sept. 7 order, U.S. District Court Judge Reed O’Connor — who previously sought to invalidate the law entirely — took issue with how preventive screenings are selected for free coverage. O’Connor said that members of the U.S. Preventive Services Task Force, a nongovernmental panel of experts that recommends procedures that should be provided at no cost, do not have proper standing to make these decisions.

Schwimmer, with the Quality Institute, said she is encouraged by the steps New Jersey has taken to ensure Obamacare’s benefits are protected on the state level. But she fears that the Texas decision, if upheld, would still impact care here since the state law requiring free access to preventive care relies on the same federal task force recommendations — guidance that is updated regularly as science evolves. “The structure and validation of the task force is a big deal,” she said.

Knock-on effects

O’Connor’s decision would not impact preventive-care recommendations made by two other clinical panels, Schwimmer said. The judge did not take issue with the format and practices of the Advisory Committee on Immunization Practices, which provides vaccine guidance to other federal regulators, and the Health Resources and Services Administration, which sets coverage rules for services to benefit infants, children and women, including reproductive health care.

The case was filed by Braidwood Management in Houston — owned by conservative Christian activist Steven Hotze, who has previously challenged Obamacare’s constitutionality — after the company objected to providing employees with free preexposure prophylaxis medication, or PrEP, a drug cocktail that can prevent HIV transmission. According to the decision, Hotze said, “providing coverage of PrEP drugs ‘facilitates and encourages homosexual behavior, intravenous drug use, and sexual activity outside of marriage between one man and one woman’,” activities that he noted are condemned by the Bible.

Policy Perspective’s Holom-Trundy said treatments like PrEP have had a positive impact on HIV/AIDS rates here and nationwide. While New Jersey had among the highest AIDS rates in the country in the early 90s, new diagnoses and deaths have declined significantly since; and there are now about 38,000 HIV/AIDS-positive residents, the vast majority Black or Hispanic. The state released a plan to “end” the epidemic by 2025, eliminating new cases through more aggressive testing, treatment and preventive strategies like PrEP.

Schwimmer is also worried that the decision illustrates a lack of understanding about health insurance in general, in which costs are shared equally but service use reflects individual need. The system would fail if people only paid for what they want to use, she explained. “You can’t pick or choose based on your religious or philosophical beliefs,” Schwimmer said. “That’s not insurance. That’s a failed plan.”

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published this page in News and Politics 2022-09-14 02:39:16 -0700