By Harris Meyer  | January 28, 2017

The Affordable Care Act extended 100% coverage for a range of preventive healthcare services, including some types of cancer screening, to seniors on Medicare. That first-dollar coverage likely saved lives by increasing diagnoses of early-stage colorectal cancer by 8% among Medicare beneficiaries during the first three years it was in effect, a new study in Health Affairs reported.

Now experts fear Republicans will eliminate the law’s mandate for full coverage of recommended preventive services in taxpayer-financed and employer-based health plans. The GOP proposals also would erase the requirement that individual plans offer minimum essential benefits in 10 categories, including mental health and substance abuse, maternity care and prescription drugs.

Even without a replacement plan, some predict the Trump administration may move quickly to ease coverage rules. The president’s recent executive order instructed federal agencies to roll back the ACA.

That could have lethal consequences for some seniors. “We found that about 8,400 people had their colorectal cancer detected at an early stage due to the first-dollar coverage, and their chance for five-year survival is much higher,” said Nengliang Yao, an assistant professor of public health at the University of Virginia, who co-authored the Health Affairs study. “That’s a lot of lives. I hope (the Republicans) will keep and strengthen prevention-related services.”

GOP proposals, including those released by House Speaker Paul Ryan and HHS secretary-nominee Dr. Tom Price, would encourage insurers to offer cheaper, high-deductible plans by eliminating various ACA mandates, including coverage of preventive services. The theory is that consumers could funnel savings from lower premiums into tax-sheltered health savings accounts to pay for voluntarily purchased cancer screening and other preventive services.

The GOP replacement plan “won’t say you can’t or shouldn’t have preventive coverage, but it won’t micromanage it,” said Tom Miller, a conservative health policy expert at the American Enterprise Institute. “Out-of-pocket medical costs compete against people’s other living costs. We should allow people to make those tradeoffs.”

MH TAKEAWAYSACA repeal puts free cancer screenings and prevention benefits for seniors and many privately insured patients at risk, although it might take a prolonged rulemaking process to make it happen.
Without a benefit mandate, private insurers would be free to limit prevention coverage to plans with higher premiums, said J.B. Silvers, a professor of healthcare finance at Case Western Reserve University and former health plan CEO.