AFTER A FEDERAL The Texas court ruling launched another potential grenade to comprehensive health coverage, a Massachusetts state council is pulling one of its lesser-known levers to make sure residents here don’t lose access to certain preventative services.
In March, US District Court Judge Reed O’Connor issued an order limiting the scope of preventative services covered by the Affordable Care Act. The decision imperils non-cost-sharing coverage for lung and skin cancer screenings, PrEP for HIV prevention, hepatitis B and C screenings, cholesterol-lowering statins and medications, and some breast cancer screenings. A provision on contraceptive coverage emerged from the ruling intact.
While the ACA has mandated for the past decade that insurers cover these services at no out-of-pocket cost to the policyholder, the new ruling would put that discretion back into the hands of insurers and providers in the next round of coverage.
The Biden administration is currently appealing the ruling, but has set off a slow-burn fuse to reduce coverage. If the ruling is upheld, it would apply to insurance policies starting in 2024.
The state isn’t waiting to find out.
“I hope we will have a united community view that prevention services without cost sharing are very important to public health, to individual health, to community health,” Massachusetts Health Connector Board member Nancy Turnbull said at a recent board meeting.
The board voted to change the state’s Minimum Creditable Coverage, or MCC, standards for insurance plans to include preventative services threatened by the federal ruling. Under Massachusetts individual coverage mandateresidents must have health care that covers specific services or pay a tax penalty, so the Health Connector’s board can push insurers to change their offerings by changing the requirements for minimum care.
While MCC doesn’t apply directly to health plans, plans often choose to meet MCC standards so their members don’t face tax penalties and so their coverage remains attractive to Massachusetts residents, Kayla Scire, associate director of policy at that Massachusetts Health Connector, he explained during the recent board meeting.
About 97 percent of Massachusetts residents have health insurance, according to the state, and MCC regulations control coverage requirements for nearly 5 million Bay State residents.
There would be little change for insurers under the new rules, health officials said, since these services are already required under the ACA.
The public hearings and comment periods on the draft regulations will start in the coming weeks. If the process goes as planned, the board will vote to approve and adopt the new regulations by early August.
Health Connector executive director Audrey Morse Gasteier said most Massachusetts companies have already said they would continue to provide coverage for these services regardless of the Texas ruling.
“These are services that consumers in Massachusetts, as well as across the country, have relied on for the past decade, thanks to the Affordable Care Act,” he said. “So, we were really pleased and grateful to see how quickly the Massachusetts carrier market came to the table to say that the erosion of these standards is not something they were interested in seeing.”
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