Mandating ‘Preventive Services’ Not What the Doctor Ordered

COMMENTARY

The Affordable Care Act, aka Obamacare, has been anything but affordable. Despite all the talk about “bending the cost curve,” benefit costs have far outpaced inflation since the 2010s and national annual health care spending is now an astounding $5 trillion. The good news is that the Supreme Court is finally examining the legality of forcing costly benefits down consumers’ throats. A favorable ruling could be a game changer for escalating health care costs. 

During recent oral arguments, the nine justices pondered whether a task force appointed by the Department of Health and Human Services’ secretary should be permitted to decide which “preventive” services health plans must cover. Given the unorthodox medical views of current HHS Secretary Robert F. Kennedy Jr., the decision will prove particularly important.

Consumers and businesses deserve to decide which plan is right for them without breaking the bank. 

Obamacare’s architects may have wanted to streamline the health care system, but the law accomplished the opposite. Under the status quo, the ACA requires insurers to cover certain “preventive” services (e.g., tobacco use screening, obesity counseling, alcohol misuse counseling) free of charge to patients. Rather than listing out all these services, the law relies on expert bodies such as the U.S. Preventive Services Task Force to recommend preventive services for inclusion into the ACA’s ever-expanding mandate. 

For example, even if patients have no reason to discuss tobacco and alcohol with their doctors, a complicated arrangement between officials, task force members and insurers forces patients to pay for substance screening and counseling anyway. 

The mandate’s consequences are even costlier for cancer screenings.

Over the past decade, low-cost services such as blood-in-stool tests have allowed patients to avoid going for a colonoscopy. Doctors are still more likely to recommend colonoscopies to patients despite the procedure’s significant costs. But because the mandate shields patients from seeing that cost, they’ll likely listen to their doctors and opt for the costlier screening. Research on colorectal cancer screening shows that, while the ACA significantly increased overall screening, colonoscopies are driving the vast majority (~85%) of the increase. 

Simply getting more people to show up for screenings is only one part of the equation. As Presidents Trump, Biden, and Obama recognized, a key part of health care reform is keeping costs under control. Even in a clinical setting, colonoscopies cost roughly three times as much as blood-in-stool tests. And, thanks to advances in medical technology, patients can order and take colon cancer tests at home for less than $100. Low-cost and innovative health care can become the norm, but only if patients have some exposure to prices. 

That can’t happen, though, if mandated “preventive services” emphasize costly and invasive procedures at the expense of more affordable alternatives. 

The reality is that innovative testing and truly preventive services will only flourish once the “preventive services” mandate and task force go away for good. That doesn’t mean patients need to file for bankruptcy to afford essential health care services. Taking Medicaid dollars (which have limited effectiveness) and converting them into Health Savings Account payments for struggling households can go a long way toward providing financial security. 

The federal government can make the most of these payments by ensuring that low-income beneficiaries have sufficient HSA funds to cover high expenses that fall just short of meeting the deductible (the point where insurers start paying).

Hopefully, the Supreme Court recognizes the folly of mandating services that consumers don’t want or need. Health care costs can stay under control, but only with a healthy regimen of choice and competition. 

David Williams is the president of the Taxpayers Protection Alliance. In his 30 years in Washington, D.C., he has become an expert in finding and exposing government waste and has advised taxpayer groups from around the world. He can be found on X.