A recent tussle over the Affordable Care Act’s (i.e., Obamacare) requirement that private health insurance cover preventive health care at no out-of-pocket cost raises a long-running policy debate: How effective is preventive health care in saving lives or money?
The answer is probably not much.
Last March, a federal judge in Texas ruled that employers cannot be required to provide most preventive health care benefits under the ACA. He did not change the coverage mandate for contraception.
The judge’s ruling focuses on technical issues related to the federal task force that determines what is considered preventive care. The Fifth Circuit Court of Appeals just issued an administrative stay, so nothing changes for now while the issue is litigated.
Numerous medical associations and patient advocacy groups weighed in on how important preventive care is in detecting diseases in their early stages. And it is important, especially with respect to certain diseases.
Mammograms, prostate cancer screenings, vaccinations, and perhaps a few others—I would include an annual physical in that list—probably do save the health care system money by detecting (or preventing in the case of vaccines) problems early.
But the task force has used a broad definition of preventive care that now reportedly includes more than 100 preventive services, testing for diseases the vast majority of people will never suffer from, though some may in their later years.
A recent analysis by the Peterson-KFF Health System Tracker found that about 60 percent of employees with employer-provided health insurance used Obamacare’s free preventive services in 2018. Of course, many—and perhaps the large majority—of them would have used preventive services anyway, even if there were a small co-pay.
Ironically, Obamacare’s free preventive services mandate has been in effect for a decade, and yet life expectancy has actually declined slightly, though partly due to the pandemic. And the country spends even more money on health care. The Centers for Medicare and Medicaid Services says, “U.S. health care spending grew 2.7 percent in 2021, reaching $4.3 trillion or $12,914 per person.”
Had all of the free preventive health care services helped, we might have expected to see an increase in life expectancy or at least a decline in the growth of health care spending.*
The point is that Obamacare’s free preventive care mandate was an overreach, part of the left’s never-ending push to make all health care “free”—i.e., paid for by taxpayers.
Some preventive care is very useful and cost effective, some isn’t. Health insurers have an economic incentive to determine which is which and provide those services free or at very little cost.
Regardless of how the courts eventually rule, the debate over preventive care coverage should be based on good health care and good economics, not bad politics.
*There was a small decline in spending, but that was related to the waning pandemic.
May 16, 2023