Impact of the 2017 Health Reform Proposals on Clinical Preventive Services

March 2017

Impact of the 2017 Health Reform Proposals on Clinical Preventive Services reviews the current status of public and private insurance coverage of preventive services, and what would be at stake if they were eliminated or reduced, either through legislation or administrative actions.

The Affordable Care Act (ACA) expanded coverage of a range of effective, targeted preventive services to make them accessible to millions of Americans. 

• As of 2015, around 137 million private insured Americans received guaranteed preventive services without cost sharing.  Small and individual insurances plans are required to cover 10 Essential Health Benefits, such as blood pressure screenings and well care visits, and non-grandfathered individual, small and large plans are required to cover evidence-based services with top effectiveness ratings, recommended vaccines and preventive maternal and child health coverage (Section 2713 Preventive Services). 
• The 14 million Americans covered via Medicaid expansion qualify for no-cost coverage of Essential Health Benefits, other top rated preventive services and tobacco cessation services.  States determine coverage of preventive services for enrollees in traditional Medicaid plans.

“For too long, America has propped up a sick care system. Instead of prioritizing keeping people healthy in the first place, we’ve waited until they get sick—often with chronic, debilitating and expensive conditions—and then paid the price,” said John Auerbach, president and CEO, TFAH. “Research tells us time and again two truths: Americans with coverage of preventive services are more likely to access these services and investing in preventive services improves health and reduces costs, yielding massive returns on investment.”

According to the brief, a range of proposals could potentially lead to millions of Americans losing access to preventive services – either through reductions or changes in requirements or as part of losing health insurance coverage.  Studies have shown that expanding coverage for preventive services contributes to an uptick in routine exams; screenings for blood pressure, cholesterol and diabetes; use of flu shots; and annual dental exams.  Examples of some outcomes of preventive services include:

• Among the Medicaid population in Massachusetts, an evidence-based, Medicaid tobacco-cessation benefit was associated with a reduction in smoking rates and an estimated $3.12 in medical savings from averted cardiovascular hospitalizations alone for each dollar spent.
• The Diabetes Prevention Program reduced risk for developing type-2 diabetes by 58 percent. Even after 10 years, people who completed the program were one-third less likely to develop type 2 diabetes.
• Comprehensive prenatal maternal care helps reduce premature birth and infant mortality rates. 
• Vaccines prevented an estimated 322 million illnesses, 21 million hospitalizations and 732,000 deaths among children born in the U.S. between 1994 and 2013 – and yield a net savings of $295 billion in direct costs and $1.38 trillion in societal costs.