Mass health officials move to protect preventive care
Change to minimum coverage could preserve services for 5m residents
AFTER A FEDERAL Texas court ruling lobbed another potential grenade at comprehensive health coverage, a Massachusetts state board is pulling one of its lesser-known levers to make sure residents here don’t lose access to certain preventive services.
US District Court Judge Reed O’Connor issued an order in March limiting the scope of preventive services covered under the Affordable Care Act. The decision imperils coverage without cost-sharing for lung and skin cancer screenings, PrEP for HIV prevention, hepatitis B and C screenings, statins to lower cholesterol, and medications and certain screenings for breast cancer. A contraceptive coverage provision made it out of the ruling untouched.
While the ACA has mandated for the last decade that insurers cover these services without out-of-pocket costs for the insured, the new decision would place that discretion back in the hands of insurers and providers in the next round of coverage.
The Biden administration is currently appealing the ruling, but it set off a slow-burning fuse to reduced coverage. If the ruling is upheld, it would apply to insurance policies beginning in 2024.
“I hope that we have a united community view that preventive 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 amend state Minimum Creditable Coverage, or MCC, standards for insurance plans to include the prevention services under threat by the federal ruling. Under Massachusetts’ individual coverage mandate, residents must have health care that covers specific services or pay a tax penalty, so the Health Connector board can nudge insurers into changing their offerings by changing the requirements for the minimum care.
“While MCC does not apply to the health plans directly, plans often choose to meet MCC standards so that their members don’t face tax penalties, and so that their coverage remains attractive to Massachusetts residents,” Kayla Scire, associate director of policy at that Massachusetts Health Connector, explained at the board’s recent meeting.
About 97 percent of Massachusetts residents have health insurance, according to the state, and the MCC regulations control coverage requirements for almost 5 million Bay State residents.
There would be little change for insurers under the new rules, health officials said, since these services have already been required under the ACA.Public hearings and comment periods will kick off in the next few weeks on the draft regulations. If the process chugs along as expected, the board would 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 plan to continue to provide coverage for these services regardless of the Texas ruling.