New Report Sheds Light on Employer Preventive Health Services Obligations

By Margaret Faso posted 04-21-2023 13:03


A new report from the University of Michigan provides useful information on which preventive services employers must continue to cover without cost sharing following a court decision striking down the Affordable Care Act provisions for preventive services coverage, pending further guidance from the Biden administration.

Background: On March 30, 2023, a federal court struck down the ACA mandate that requires employer health plans to cover, without cost sharing, certain preventive service recommendations of the U.S. Preventive Services Task Force (USPSTF) that have an “A” or “B” rating. The Department of Justice filed an appeal on March 31, 2023, and a motion for a stay on April 12, 2023 which was denied this week. The Biden administration posted guidance on April 13 regarding the case.      

The new University of Michigan report found:

  • About one-third of the 46 preventive services recommendations that employer plans have been required to cover for free under the ACA would continue to have a no cost-sharing requirement under the court decision. This includes screenings for lung cancer or gestational diabetes and the HIV PrEP drug regimen.

  • The no cost-sharing requirement would be dropped for another third, including screenings for depression in adults and for breast cancer.

  • The impact of the court decision on the final third of the Task Force’s recommendations is uncertain and requires further Labor Department guidance. This includes screening for osteoporosis, colorectal cancer, and cervical cancer.

More guidance needed. Mark Wilson, Vice President, Health and Employment Policy told Bloomberg that HR Policy has asked the Department of Labor to clarify which Task Force recommendations are impacted by the court decision while commenting that the immediate impact on employers will be limited “until the litigation is resolved.”