PPACA's Preventative Services Mandate: Change on the Horizon for Health Care

The Patient Protection and Affordable Care Act (PPACA) has transformed the American health care system into one that promotes public health by making evidence-based preventive services available nationwide through private and government-funded health plans. [1​]  PPACA requires private insurers, with the exception of those “grandfathered” in, to cover a list of preventive services, without any patient cost-sharing, in the form of copayments and deductibles. [2]

 

The Coverage of Preventive Health Services section of PPACA (hereafter, the Mandate), serves as a method of lowering the cost of health care. [3] With the appropriate preventive care, health issues can be identified sooner, managed more efficiently, and treated before they develop into more complicated and costly illnesses. [4] Waiting to treat illness until a person is sick, instead of focusing on prevention, has a direct effect on the rising health care costs in the U.S. and has caused many Americans to delay necessary doctor visits.

The Mandate covers forty-five evidence-based preventive services that have been given a certain rating by the United States Preventive Services Task Force (USPSTF). [5]  This Mandate represents a major breakthrough for national health care reform because this legislation focuses on prevention rather than curative care, thereby creating a more healthy population and a less fragmented health care system.

PPACA requires private insurance plans to cover a broad range of services under four broad categories: evidence-based items or services, routine immunizations, childhood preventive services, and preventive services for women. [6] The requirement that insurers provide coverage for routine immunizations, childhood preventive services, and evidence-based services went into effect on all non-grandfathered plans beginning on September 23, 2010. [7] Beginning August 1, 2012, non-grandfathered insured plans were also required to cover the additional services recommended for women’s preventive health care. [8]

The Nation Commission on Prevention Priorities in a recent study stated, “increasing delivery of just five clinical preventive services would avert 100,000 deaths per year.” [9] A recent study, conducted by medical researchers at the Robert Wood Johnson Foundation, found that 90% more lives could be saved and costs could be reduced up to 30% over ten years if preventive protection elements are added to insurance coverage and medical care. [10] Chronic diseases are responsible for 70% of all deaths among Americans each year and account for 75% of the nation’s health care spending. [11] These chronic illnesses can largely be prevented through the use of early detection and other preventive measures.

While preventive care will eventually lead to lower costs in health care, providing these services at no cost to the insured could have serious economic, political, and legislative impacts on the current health care system. Although the exact economic impact that these new requirements will have on an individual’s premiums are unknown, the effects are likely to vary greatly from state to state and plan to plan. [12]

 

References:

[1] John A. Cogan, Public Health Reform: PPACA Implications for Public Health: The ACA’s Preventive Services Mandate: Breaking Down the Barriers to Nationwide Access to Preventive Services, 39 J.L. Med. & Ethics 355, 355 (2011).

[2] Preventive Services Covered by Private Health Plans under the Affordable Care Act, The Henry Kaiser Family Foundation (Sep. 2011), http://kaiserfamilyfoundation.files.wordpress.com/2013/01/8219.pdf.

[3] Patient Protection and Affordable Care Act, Pub. L. No. 111-148, §2713, 124 Stat. 119 (2010).

[4] Preventative Services, supra.

[5] §2713.

[6] §2713.

[7] Preventative Services, supra.

[8] Supra.

[9] National Commission on Prevention Priorities, Preventive Care: A National Profile on Use, Disparities, and Health Benefits. Washington, DC: Partnership for Prevention, (2007).

[10] B. Milstein, et. al, Why Behavioral and Environmental Interventions are Needed to Improve Health at Lower Cost, Health Affairs: Project Hope (May 2011), http://www.rwjf.org/en/topics/rwjf-topic-areas/prevention.html.

[11] Id.

[12] Kaiser, supra.