Braidwood Management v Becerra Puts Over a Decade of Progress in Preventive Health Care At Risk

WASHINGTON (Oct. 17, 2023) — A brief filed on behalf of 111 public health and health law and policy Deans and Scholars, the American Public Health Association, the Robert Wood Johnson Foundation, Trust for America’s Health, and ChangeLab Solutions highlights new findings on the preventive health gains at stake in Braidwood Management v Becerra. The case is now pending in the United States Court of Appeals for the Fifth Circuit. Briefing by the parties and amici is set to finish, and oral arguments are expected in the coming months. 

On appeal, the plaintiffs have reinstated their initial claim, which argues that all free preventive benefits guaranteed by the Affordable Care Act are unconstitutional. Swept into their claims, as a result, are not only recommendations made by the United States Preventive Health Services Task Force (USPSTF) since March 2010, but also all recommendations related to women’s health, children’s health, and vaccines adopted since passage of the Affordable Care Act. Braidwood would  have far-reaching consequences, and according to the research, especially affect maternal and child health care.

“The evidence is overwhelming that mothers and children in particular take advantage of free preventive services,” Anne Markus, professor and Chair of the Department of Health Policy and Management at the George Washington University Milken Institute School of Public Health, said. “In the absence of prevention, much more expensive remedial treatments will follow.  The old adage ‘penny wise and pound foolish’ springs to mind.”

Major Findings Across Four Separate Analyses

The Deans and Scholars / APHA brief draws on evidence contained in a series of new analyses regarding the potential health impact of Braidwood. Together the analyses, prepared by researchers at Milken Institute School of Public Health at the George Washington University,  contain the following major findings:

Maternal and child health

• If the plaintiffs were to prevail, more than  75 percent of 125 covered procedures of importance to maternal and child health would be affected.  Ninety procedures would be fully eliminated and five procedures whose reach into the population has been expanded since 2010 would be scaled back. One procedure would lose essential post-2010 modifications aimed at improving its effectiveness. 

• Among the services that would be entirely lost is the HHS Recommended Uniform Screening Panel (RUSP) for newborns, which guarantees coverage of a national, uniform set of newborn screening procedures for all infants, such as hearing screening, blood tests, and screening for hereditary disorders (such as cystic fibrosis and severe immunodeficiencies). Other infant services that would be eliminated include immunizations against Respiratory Syncytial Virus (RSV) vaccine, COVID-19 vaccine, and DTaP/IPV/Hib/HepB. Also lost would be fluoride varnish for infants and young children once teeth erupt, behavioral screening for children and adolescents, and blood pressure measurement.
• For mothers, coverage would be eliminated for a range of preventive services including gestational diabetes screening, diabetes mellitus screening after pregnancy, preeclampsia screening, maternal depression and intimate partner violence screening, screening for unhealthy drug and alcohol use in pregnancy, immunization against RSV vaccine and the COVID-19 vaccine, and contraception.

• Among the 24 recommended procedures for which coverage would be lost for children and adolescents are screening for anxiety, behavioral screenings, prevention services for alcohol, tobacco, and drug usage, cardiovascular risk reduction services, universal cholesterol screenings, Hepatitis C screenings, provision of fluoride varnish, and key immunizations such as COVID-19. Adolescents would lose hypertension screening, provision of the Varicella and Meningococcal vaccines, HIV screens, and Hepatitis B screens for low-risk youth.

According to the authors, use of these services is widespread, and between 2018 and 2022 their use increased dramatically. An analysis of billions of private insurance claims in the FAIR Health National Private Insurance Claims (FH NPIC®) dataset shows enormous and growing use.  An analysis of 2.8 billion private insurance claims in 2022 shows that:

• Over 4.6 million people used contraception and more than 3.2 million women used coverage for free well-women visits. 
• More than 300,000 people received diabetes screening during pregnancy, with another 50,000 screened postpartum.
• Over 276,000 infants and young children received fluoride varnish to prevent caries.
• Nearly 4 million children and adolescents were screened for psychosocial conditions.
• Hepatitis C screening among women of childbearing age surpassed 2.3 million.
• Over 195,000 women were tested and counseled for BRCA gene mutations, which can lead to breast cancer. 

A further analysis, of 1.4 billion longitudinal claims in 2018 and 2.8 billion longitudinal claims in 2022, shows substantial increases in use of covered services:

• A 118.4% increase in Hepatitis C screening for women of reproductive age.
• A 94% increase in screening for BRCA-related breast cancer gene mutations.
• A 92.9% increase in psychosocial and behavioral health exams of children.
• An 84.3% increase in perinatal depression screening.
• A 47.1% in newborn panel screening.
• A 55.7% increase in fluoride varnish for infants and young children.
• A 36.8% increase in well-woman exams.

Access to Free Immunization Services

Coverage for numerous immunizations at no cost also is at risk, including the flu vaccine and the newly approved, lifesaving RSV vaccine for pregnant women and infants. 

Access to Preventive Care in Underserved Communities

Particularly hard hit could be residents of medically underserved urban and rural communities who depend on community health centers for primary care, since preventive care coverage enables health centers to expand the reach of their preventive care activities. An analysis of national community health center data in 2022 shows that millions of patients depend on CHCs for preventive care:

• Nearly 11 million patients were screened for childhood, adult, or postpartum depression.
• Nearly 10 million patients received covered preventive care for obesity.
• Seven million patients were tested for HIV.
• One in six patients had a hypertension diagnosis, likely following a preventive screening.
• Nearly 3 million were diagnosed with diabetes following a screening.
• More than 2.7 million patients were prescribed statins or were screened for colorectal cancer.
• Over one million adolescents and adults were tested for Hepatitis B.

“Nationally, community health centers are a cornerstone for access to preventive care,” Feygele Jacobs, Director of the Geiger Gibson Program in Community Health and Professor of Health Policy and Management at GW, said. “If free preventive care is eliminated as a result of Braidwood, millions of people could lose coverage. This affects not only their immediate and long-term health but jeopardizes the stability of preventive care services in medically underserved communities.”

-GW-