Gov. Gretchen Whitmer ordered the state Department of Insurance and Financial Services on Monday to take immediate action to protect Michiganders from potentially losing health insurance coverage for preventive services, including colon and lung cancer screenings, and for preventive cancer drugs of the breast, heart disease and HIV.
Whitmer’s action comes after a federal judge in Texas struck down a provision in the Affordable Care Act that required insurance companies to fully cover certain preventive health services, a ruling that could have ripple effects in Michigan and across the country.
U.S. District Judge Reed O’Connor of the Northern District of Texas ruled last week in Braidwood Management v. Becerra that the ACA’s requirement that private health insurance companies cover services recommended by the US Preventive Services Task Force at no cost to patients is unconstitutional. He said the members of the task force are volunteers who are not appointed by the president or confirmed by the Senate, as required.
What services will be affected by Becerra’s decision?
The decision is effective immediately and applies nationwide, allowing insurance companies the right to deny full coverage of any preventive health services recommended by the task force after March 23, 2010 – the day former President Barack Obama signed the ACA into effect .
That means patients may soon find that their insurance companies will no longer fully cover statin drugs to prevent heart disease, preventive chemotherapy for those at high risk of breast cancer, lung cancer screenings or colonoscopies for people between the ages of 45-49 – newly changed the recommendation because rates of colon cancer have risen in recent years among younger Americans.
Separately, O’Connor also ruled that ACA-mandated HIV pre-exposure prophylaxis, also known as PrEP, was unconstitutional and violated Braidwood Management’s right to religious freedom.
Although the decision is effective immediately, it is unlikely that most health insurance companies will immediately withdraw full coverage of these health services. That’s because health plan contracts typically cover the entire calendar year, and changes in coverage or costs typically don’t change mid-year.
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The decision “will put people’s health at risk and could raise bills”
The US Department of Justice appealed the decision, seeking a stay from the 5th Circuit Court of Appeals. It could potentially be considered by the US Supreme Court.
“Protecting access to affordable screenings for early detection of colon and skin cancer, high blood pressure, and other preventive health services will save lives, reduce overall health care costs, and ensure a stable, healthy workforce for Michigan employers.” , Whitmer said in a statement. “The recent federal decision that reduces the requirements for insurers to cover these services will put people’s health at risk and could raise their bills. That’s why I’m taking action today to protect preventive health services that have long been covered by their insurance, so Michiganders can get the care they need without worrying about whether they can afford it.”
Whitmer directed the Department of Insurance and Financial Services to issue guidance so that Michigan residents can better understand which preventive health services are affected by O’Connor’s decision and to develop recommendations and begin working immediately with health insurance companies. to determine what steps can be taken to ensure continued affordable coverage.
“The recent court decision threatens access to preventive health services that allow Michiganders to address health problems before they become serious, when they can be more successfully treated,” said Anita Fox, director of the state Department of Insurance and financial services, in a statement.
In a letter Whitmer sent to Fox on Monday, the governor pledged to urge the state Legislature and Congress to codify full coverage of these preventive health services “to help ensure that Michiganders can continue to have access to these critical services without worrying about affordability. The time to act is now. No one in Michigan should have to choose between paying their bills and protecting their health.
Michiganders with questions about their health insurance can go to Michigan.gov/HealthInsurance or call 877-999-6442, 8:00 a.m. to 5:00 p.m., Monday through Friday.
Contact Kristen Shamus: [email protected]. Follow her on Twitter @kristenshamus. Subscribe to the free press.