Bit by bit, the Affordable Care Act (ACA; AKA Obamacare) is (thankfully) getting weaker. The first blow came in 2017 when congressional Republicans effectively eliminated the infamous individual mandate that penalized Americans for not buying health insurance. And now, courts are casting doubt on the law’s provisions mandating insurer coverage of costly services.
Recently, U.S. District Judge Reed O’Connor ruled that the selection process for bureaucrats making ACA coverage recommendations is unconstitutional. While the ruling’s ramifications are still unclear, striking down coverage mandates would result in greater choice and lower prices across the health care system. Lawmakers should take this rare opportunity to legalize low-cost and innovative health care services.
Obamacare’s architects may have wanted to streamline the health care system, but the law accomplished the opposite. Under the status quo, the ACA requires insurers to cover certain “preventative” services (e.g., tobacco use screening, obesity counseling, alcohol misuse counseling) free-of-charge to patients. Rather than listing out all these services, the law relies on expert bodies such as the U.S. Preventative Services Task Force to recommend preventative services for inclusion into the ACA’s ever-expanding mandate. Even if patients have no reason to discuss tobacco and alcohol with their doctors, a complicated arrangement between officials, Task Force members, and insurers forces patients to pay for substance screening and counseling anyway.
O’Connor’s ruling that Task Force members were unconstitutionally appointed will likely complicate the status quo and cast doubt on Task Force recommendations. But, the “preventative services” mandate is still in place, and that’s bad news for patients trying to find affordable health plans.
For example, the ACA mandate currently extends to colorectal cancer screenings. Over the past decade, low-cost services such as blood-in-stool tests have allowed patients to avoid going for a colonoscopy. Doctors are still more likely to recommend colonoscopies to patients despite the procedure’s significant costs. But because the mandate shields patients from seeing that cost, they’ll likely listen to their doctors and opt for the costlier screening. Research on colorectal cancer screening shows that, while the ACA significantly increased overall screening, colonoscopies are driving the vast majority (roughly 85%) of the increase.
Simply getting more people to show up for screenings is only one part of the equation. As Presidents Barack Obama and Joe Biden recognized, a key part of health care reform is to bend down the cost curve. Even in a clinical setting, colonoscopies cost roughly three times as much as blood-in-stool tests. And, thanks to advances in medical technology, patients can order and take colon cancer tests at home for less than $100. Low-cost and innovative health care can become the norm, but only if patients have some exposure to prices.
This “skin in the game” will only become a reality once the preventative services mandate goes away for good. That doesn’t mean patients need to file for bankruptcy to afford essential health care services. Taking Medicaid dollars (which have limited effectiveness) and converting them into health savings account (HSA) payments for struggling households can go a long way toward providing financial security. The federal government can make the most of these payments by ensuring that low-income beneficiaries have sufficient HSA funds to cover high expenses that fall just short of meeting the deductible (the point where insurers start paying).
This strategy would help bend the cost curve and give millions of Americans greater health care choices with minimal restrictions and red ink. Policymakers must reject mandates and embrace life-saving innovations.
David Williams is the President of the Taxpayers Protection Alliance.