Gov. Whitmer fears impact of ruling that free ACA screenings are unconstitutional

Gov. Gretchen Whitmer directed the state Department of Insurance and Financial Services on Monday to move immediately to protect Michiganders from the potential loss of health insurance coverage for preventive services, including colon and lung cancer screenings, and for preventive drugs for breast cancer, heart disease and HIV.

Whitmer's action comes after a federal judge in Texas struck down a provision in the Affordable Care Act that requires insurance companies to fully cover certain preventive health services, a ruling that could have major ripple effects in Michigan and across the country.

U.S. District Judge Reed O'Connor of the Northern District of Texas ruled last week in Braidwood Management v. Becerra that the ACA's requirement that private health insurance companies cover services recommended by the U.S. Preventive Services Task Force at no cost to patients is unconstitutional. He said the task force members are volunteers who are not appointed by the president or confirmed by the Senate as required.

What services would be affected by Becerra ruling?

The ruling is effective immediately and applies nationally, allowing insurance companies the right to deny full coverage of any preventive health services recommended by the task force after March 23, 2010 — the day former President Barack Obama signed the ACA into law.

That means patients could soon find that their insurance companies will no longer fully cover statin drugs to prevent heart disease, preventive chemotherapy for those at high risk for breast cancer, lung cancer screenings or colonoscopies for people between the ages of 45-49 — a newly changed recommendation as the rate of colon cancer has risen in recent years among younger Americans.

Separately, O'Connor also ruled that ACA-mandated coverage of HIV pre-exposure prophylaxis, also known as PrEP, is unconstitutional and violates Braidwood Management's right to religious freedom.

Although the ruling takes effect immediately, it's unlikely most health insurance companies will withdraw full coverage of these health services right away. That's because health plan contracts typically span the full calendar year and changes to coverage or costs typically don't change midyear.

More: Simple lung cancer screening test is easy, painless — and could save your life

More: Thousands miss out on HIV-prevention treatment in Michigan, nationally

Ruling 'will put people's health at risk and could raise bills'

The U.S. Department of Justice has appealed the ruling, seeking a stay from the 5th Circuit Court of Appeals. It could potentially be considered by the U.S. Supreme Court.

“Protecting access to affordable early detection screenings for colon and skin cancer, high blood pressure and other preventive health care services will save lives, reduce overall health care costs and ensure a stable, healthy workforce for Michigan employers,” Whitmer said in a statement. “The recent federal ruling striking down requirements for insurers to cover these services will put people’s health at risk and could raise their bills. That’s why I am taking action today to protect preventive health services that have long been covered by their insurance so Michiganders can get the care they need without worrying about whether they can afford it.”

Whitmer directed the Department of Insurance and Financial Services to issue guidance so Michiganders can better understand which preventive health care services are affected by O'Connor's ruling, and to develop recommendations and begin working immediately with health insurance companies to determine what steps can be taken to ensure continued affordable coverage.

“The recent court decision jeopardizes access to preventive health care services that allow Michiganders to address health problems before they become serious, when they can more successfully be treated,” said Anita Fox, director of the state Department of Insurance and Financial Services, in a statement.

In a letter Whitmer sent to Fox on Monday, the governor pledged to call on the state Legislature and Congress to codify full coverage of these preventive health services “to help ensure that Michiganders can continue to have access to these critical services without having to worry about whether they can afford it. The time to act is now. No person in Michigan should have to choose between paying their bills and protecting their health.”

Michiganders with questions about their health insurance can go to Michigan.gov/HealthInsurance or call 877-999-6442, 8 a.m.-5 p.m. Monday through Friday.

Contact Kristen Shamus: kshamus@freepress.com. Follow her on Twitter @kristenshamus. Subscribe to the Free Press.

This article originally appeared on Detroit Free Press: Whitmer fears impact of ruling that free ACA screenings are illegal