The ACA’s Preventive Services Benefit Is in Jeopardy: What Can States Do to Preserve Access?

By Justin Giovannelli, Sabrina Corlette, and Madeline O’Brien

A federal judge is poised to gut one of the most popular provisions of the Affordable Care Act (ACA). The ACA requires that most private health plans cover preventive services, such as certain cancer screenings and immunizations, without imposing cost sharing on enrollees. In September of last year, a judge in the Northern District of Texas ruled that much of the ACA’s preventive services requirement is unconstitutional. While the litigation may take years to play out, this case has the potential to cut off millions of peoples’ access to crucial health services, ranging from contraceptives to flu shots.

If the federal preventive services protection is eventually struck down, states that have codified the ACA requirement can protect access to preventive care for at least some of their residents. Although state coverage requirements cannot protect enrollees in self-funded employer plans, tens of millions of people get coverage in the individual market or through a fully insured group plan, and states have full authority to regulate on behalf of these consumers.

In a post for the Commonwealth Fund’s To the Point blog, Georgetown researchers identify current state-level preventive service coverage requirements. At least 15 states have broad, ACA-style laws requiring individual market insurers to cover, without cost sharing, the same categories of preventive services required by the ACA. Several states have extended these protections to workers in the fully insured group market. However, state rules are generally patchwork, and don’t usually require that benefits be provided free of cost sharing. States may wish to pursue multiple strategies to close these gaps and prevent individual market (and many group market) enrollees from losing access to preventive care.

You can view the full blog post and a map of state laws here.