Released on Sep 16, 2022

Future Coverage of Preventive Services without Cost Sharing Uncertain after Texas Judge’s Ruling

A federal judge in Texas has ruled that members of the U.S. Preventive Services Task Force (USPSTF) are unconstitutionally appointed, putting in jeopardy patient access and affordability of preventive services currently recommended by the USPSTF, including colorectal cancer screening.

The decision is the outcome of a suit filed by six individuals and two businesses who challenge the legality of the preventive-care mandates under the Constitution and the Religious Freedom Restoration Act. According to court documents, the plaintiffs want the option to purchase health insurance that excludes or limits coverage of pre-exposure prophylaxis (PrEP) drugs to prevent HIV infection, contraception, the HPV vaccine, and screenings and behavioral counseling for STDs and drug use.

The Affordable Care Act requires most private health insurance to cover certain preventive care services without cost sharing, including those that receive an “A” or “B” rating from the USPSTF. In his written opinion, District Judge Reed O’Connor stated that because members of the USPSTF are principal officers of the United States, constitutional methods for appointing them (nominated by the President and confirmed by the Senate) must be followed.

“Judge O’Connor’s ruling creates uncertainty around the future availability of preventive services, including colorectal cancer screening, without patient cost sharing,” said ASGE President Bret Petersen, MD, MASGE.  “We know that consumers put off preventive care when they have to reach into their pocketbooks for colonoscopies, mammograms and other potentially life-saving services. It's therefore imperative that all preventive services recommended by the USPSTF remain available to consumers without cost-sharing requirements.”

The Court will next hear from the Biden Administration attorneys (defendant) and plaintiffs on an appropriate remedy. However, the Judge has already warned that if the Administration attorneys argue that a remedy is to allow the Secretary of Health and Human Services to ratify the actions of the USPSTF, the defendants have already disclaimed that the Secretary has any authority over the USPSTF, and, without that authority, there can be no ratification.

The Administration is expected to appeal the ruling. Prior to consideration of the case, ASGE signed a joint statement on preserving access to preventive services.


About Gastrointestinal Endoscopy
Gastrointestinal endoscopic procedures allow the gastroenterologist to visually inspect the upper gastrointestinal tract (esophagus, stomach and duodenum) and the lower bowel (colon and rectum) through an endoscope, a thin, flexible device with a lighted end and a powerful lens system. Endoscopy has been a major advance in the treatment of gastrointestinal diseases. For example, the use of endoscopes allows the detection of ulcers, cancers, polyps and sites of internal bleeding. Through endoscopy, tissue samples (biopsies) may be obtained, areas of blockage can be opened and active bleeding can be stopped. Polyps in the colon can be removed, which has been shown to prevent colon cancer.

About the American Society for Gastrointestinal Endoscopy
Since its founding in 1941, the American Society for Gastrointestinal Endoscopy (ASGE) has been dedicated to advancing patient care and digestive health by promoting excellence and innovation in gastrointestinal endoscopy. ASGE, with almost 15,000 members worldwide, promotes the highest standards for endoscopic training and practice, fosters endoscopic research, recognizes distinguished contributions to endoscopy, and is the foremost resource for endoscopic education. Visit Asge.org and ValueOfColonoscopy.org for more information and to find a qualified doctor in your area.

 

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