Smart teamwork protects access to cost-free preventive care

Opinion editor's note: Editorials represent the opinions of the Star Tribune Editorial Board, which operates independently from the newsroom.

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The latest legal challenge to the Affordable Care Act is a reminder that the tiresome political battle over the 2010 landmark health law often comes with collateral damage. Patients and their pocketbooks stand to lose if the Texas plaintiffs who filed Braidwood Management v. Becerra ultimately prove successful, with the case widely expected to wind up before the U.S. Supreme Court.

At issue is whether one of the ACA's most popular provisions — its requirement that health plans cover more than 100 recommended preventive services without copays, coinsurance and deductibles — is constitutional. A ruling by a Texas U.S. District Court judge already known for his dubious ACA jurisprudence doubts that it is, potentially limiting cost-free access to some types of this vital care for the millions who struggle with medical care's high cost.

Fortunately, smart teamwork by the state Department of Commerce and legislators this year created safeguards to protect as many Minnesotans as possible from surprise bills. Conscientious legislation passed this session requires insurers regulated by the state to continue providing ACA preventive care cost-free no matter the Texas case's outcome.

This is only a partial solution because roughly 18% of Minnesotans have health plans regulated by the state. Most big employer plans are under federal oversight. Nevertheless, the new measures are a pragmatic response to the uncertainties created by yet another imprudent attempt to weaken the ACA.

The new state-level protections also commendably make a pointed reference to providing cost-free access to medications (often called PrEP) that are highly effective at preventing HIV infection during sex or injection drug use. HIV is the virus that can lead to AIDS. The Braidwood plaintiffs claimed that requiring PrEP violates their religious rights, and the judge agreed. The Minnesota reform helps ensure at-risk groups here won't be cut off from this critical treatment.

Preventive care includes screenings for cancer, high blood pressure, sexually transmitted diseases, osteoporosis, anxiety and depression, among others. The Braidwood decision doesn't jettison cost-free access to all preventive care. Instead, it strikes down no-cost coverage for services recommended or updated by the USPSTF after 2010, according to a Kaiser Family Foundation brief.

Significant USPSTF revisions since 2010 include expanding colon cancer screening to include adults ages 45 to 49. Lung cancer screening was also expanded. Another change: recommending medication for women age 35 and older who are at high risk of breast cancer. PrEP is another recommendation added during this time. All these could now be subject to cost-sharing, which may make them less accessible for people with high-deductible health plans or other financial pressures.

As the KFF brief notes, the ruling would "effectively lock in place coverage requirements based on evidence from 13 years ago." A recent survey by the American Cancer Society's Cancer Action Network adds to concerns about the ruling's impact. A majority of cancer patients and survivors said they would be "less likely to maintain preventive care, including recommended cancer screenings, if the mandate for full coverage is repealed."

Minnesota Commerce Commissioner Grace Arnold and her team merit praise for tracking the case and then drafting the new state-level protections to protect patients. The new protections go into effect Aug. 1.

Arnold accurately called the protections "common sense." She said the new state requirements shouldn't increase insurance costs because they keep current coverage requirements in place and thus are "baked into" existing premiums. Preventing more serious health conditions can also yield savings.