House passes ACA replacement—with potential to reduce screening

The U.S. House of Representatives passed a bill to repeal and replace the Affordable Care Act (ACA) by a narrow vote, sending the American Health Care Act (AHCA) to the Senate for the next stage in a pitched legislative battle.

While the current bill resembles the first iteration that was pulled from the House floor in March before a vote was held, it holds one important distinction for radiology: It allows states to waive the requirement that health plans cover essential health benefits, including preventative care.

Under the Affordable Care Act, insurers were required to cover out-of-pocket costs for exams with an “A” rating from the U.S. Preventative Services Task Force (USPSTF), including mammography, colorectal cancer and cervical cancer screening. Lowering the financial barrier increased mammography rates, especially among the poorest cross-sections of the population, according to a study published in Cancer. This has potential of reducing mortality and cost to the healthcare system.

“Anyone will tell you that preventative care is the most cost-effective way to practice medicine,” said University Hospitals' Gregory Cooper, MD, an author on the study.

Imaging societies such as the American College of Radiology agree wholly, according to Director of Congressional Affairs Chris Sherin.

“It’s something we think makes a lot of sense,” said Sherin. “Detecting disease early is fiscally responsible because you can treat something at an earlier stage when it’s cheaper to treat, but it’s also a great thing for the patient, because you’re catching it earlier when it’s more likely to be cured.”

The AHCA allows states to waive any of 10 essential health benefits if the state can demonstrate it will lower premiums—a virtual certainty when states can charge patients higher premiums for pre-existing conditions. Reinstating the financial barrier of out-of-pocket costs could have a deleterious effect on mammography usage, to the detriment of the American citizen: Breast screening has been inarguably successful, reducing breast cancer mortality by almost 37 percent since it’s widespread implementation in the mid 1980s.

However, the bill faces an uphill climb in the Senate: Republicans can only afford to lose two votes within their caucus. The updated Congressional Budget Office (CBO) score is likely to be similar to the score of the March bill, which predicted up to 24 million people would lose insurance coverage.

The bill is expected to undergo substantial changes in the Senate, providing an opportunity for imaging advocates to make their voices heard.