No need to panic over talk of cutting essential health benefits, including low-cost preventative screening

While the Affordable Care Act (ACA)’s essential health benefits are now on the chopping block to entice the more conservative members of the House into supporting the American Health Care Act, losing the requirement that insurers cover preventative cancer screening isn’t a foregone conclusion.

According to the American College of Radiology (ACR)’s Executive Vice-President of Government Relations Cynthia Moran, the bill still has a long way to go before President Trump signs anything into law.

“The senate will be the ultimate arbiter. They will decide what goes in it,” she said, in an interview with Radiology Business. “There will be opportunities for us to express our concerns and argue that early detection saves lives, especially once it goes to implementation through HHS—assuming it passes at all.”

The cost-effective nature of preventative screening may be its saving grace, according to Moran.

In fact, she believes the provision for low-co-pay preventative screening could be debated separately from other essential health benefits. It’s not an overtly politicized issue and multiple studies have shown lowering co-pays increases screening efficacy—leading to longer, healthier lives for patients while reducing costs to the system.

“Anyone will tell you that preventative care is the most cost-effective way to practice medicine,” said Gregory Cooper, MD, co-author on a study finding that mammography rates increased after implementation of the ACA, especially among the poorest cross-sections of the population.

While the essential health benefits are defined by law, the ACA gave the Secretary of Health and Human Services wide latitude in how he or she applies them, allowing Secretary Price to delegate them to individual states. This approach was touted by Mick Mulvaney, director of the Office of Management and Budget, in a CBS News appearance.

“If you live in a state that wants to mandate maternity coverage for everybody, including 60-year-old women, that’s fine,” he said. "What we’re doing is taking away the federal control of these systems.”

Further, while the ACR is officially taking a neutral position on the American Health Care Act (ACHA), Moran expressed more general concerns about removing essential health benefits.

“Many of these define what health insurance is. Assuming this passes and becomes enacted into law, what kind of insurance product is created?” she said. “It could look like a Chinese take-out rather than insurance plans—trying to understand what is covered and not covered could be very difficult for the average consumer.”

It’s important to note while radiology isn’t immune to the deleterious effects of 24 million Americans losing health insurance, imaging advocates believe there’s plenty of time to make the case for low-cost preventative screening.

“There’s still plenty of questions how this particular issue of low-cost screening co-payments gets dispensed with through the legislative process and then the rulemaking process of HHS,” said Moran. “That’s going to be a long road to travel, and we will be part and parcel of those conversations throughout that process.”