Dr Mark Fendrick Talks About Clinical Effects of the Braidwood Ruling

Preventive care could take a step back by reverting to measures enacted prior to March of 2010, according to A. Mark Fendrick, MD, director of the V-BID Center at the University of Michigan and the co–editor in chief of The American Journal of Managed Care.

Transcript

What are the clinical implications of the Braidwood v Becerra ruling on accessibility of preventive care?

It's my pleasure to join my UofM [University of Michigan] colleague and legal expert, Professor Bagley [Nicholas Bagley, JD] on this. It's been very challenging, having been involved with the preventive care mandate of the ACA [Affordable Care Act] from the beginning, to see this challenge, given the profound effect it has had on millions of Americans. Our own analyses and others have shown that the impact regarding access to these potentially lifesaving preventive services are disproportionately benefited by underserved populations, communities of color, low-income individuals, and those who live in rural places.

I think there have been some public health advocates who've talked about a specific aspect of this case, in the fact that it's allowable, and actually mandated, that any US Preventive Services Task Force recommendation before the signing of the ACA in March of 2010, must stay in place. I have, as a clinician and someone who's been following this very closely, some reservations about that, given that there are now 46 services that have an A or B rating by the Task Force, thus the requirement of zero cost sharing for these services.

Interestingly, 15 of these have been designated an A or B rating since 2010; some of them for the first time, like anxiety screening and pre-exposure prophylaxis for HIV that's gotten a lot of attention. But they're also some of these services that have been upgraded from a non–A/B to an A/B, like lung cancer screening, which is now a very popular and very effective intervention that is covered with zero cost sharing.

I think it's also important to point out that 17 of these 46 have been changed substantially. That either the populations that are impacted have changed or the modality of the preventive service has changed. And one example where that's happened in both is colorectal cancer screening. Colorectal cancer screening, its last iteration, not only included aged, average-risk people between 45 and 49—which is 20 million Americans who now have access to no-cost colorectal cancer screening—but the updates since 2010 also include new interventions such as stool DNA testing, which is a noninvasive way to screen for colorectal cancer.

So when you see that either populations or modalities have changed, or a new A or B rating since 2010, that's almost two-thirds of the 45. That leaves 14 of the 46 that have basically remained unchanged. So for those who are thinking, "Oh, it's okay, that we're going to be able to just keep these older recommendations," I think those people are underestimating the clinical impact of this Braidwood ruling.