Convincing patients to get mammograms, reproductive care and colonoscopies is a huge part of Allison Ruff’s job as a primary care doctor at the University of Michigan.
“I spent three years probably convincing this one male patient in his 60s to get his colonoscopy,” she said.
He finally got the procedure and told Ruff that doctors found and removed a precancerous growth.
“He was totally overwhelmed. He was like, ‘Thank you, doc. They were able to remove it completely. I don't have cancer,’” she said. “But if we'd waited another year, it would have been a very different conversation.”
There are few guaranteed free parts of American health care. But for the last 15 years, we've all become accustomed to getting screenings for cancer, diabetes and infectious diseases, knowing our insurance will pick up the whole tab. That could all go away if the Supreme Court sides with two Texas businesses.
This is the fourth time the justices are hearing a challenge to the law, and a decision is likely coming this summer.
Since 2010, screening rates for colon cancer, chronic diseases and vaccinations have increased. That’s when the Affordable Care Act required insurers to pay for these kinds of important preventive care.
“High-value things should be cheap, and low-value things should be expensive,” said Dr. Mark Fendrick. This idea that Fendrick and a colleague came up with is called value-based insurance design. He now runs a center with that name at the University of Michigan.
Fendrick’s idea made it into the ACA. Now, every year, an independent panel of doctors and medical experts update which preventive care should be free for patients.
“And one of the great things about it is it's a gift that keeps on giving,” he said.
But in 2020, two Texas businesses disagreed. They say in court filings filings that the requirement to pay for HIV prevention meds, contraception and STD testing through company insurance violates their religious beliefs. They argue the medical experts who decide which preventive care should be free were illegally hired and are too independent.
When Fendrick heard about the case he said it felt like a “punch in the gut,” he said. “This is something that I advocated for for many years and — most importantly — actually saw the impressive impact on patient behavior.”
He worries if the justices overturn this guaranteed free care, it could reverse more than a decade of public health progress.
This case threatens a return to the days before standardized coverage, noted Zach Baron, director of the Center for Health Policy and the Law at Georgetown.
“At the end of the day, this case is about whether [insurers and employers] can sort of go back to the Wild West that we had before the Affordable Care Act was signed into law,” he said.
Even if the mandate does go away, most businesses say they plan to keep paying for this care, in part because it saves money long-term.
