President-elect Trump and the Republican leadership continue to declare their intent to largely reverse the Affordable Care Act (ACA), the legislation responsible for insuring 21 million more Americans since its inception in 2010.
There are two provisions, however, that he has vowed to keep due to their broad popularity: no exclusion of pre-existing conditions and coverage up to age 26 on a parent’s health plan. There is a third provision that we must urge Mr. Trump and our legislators to retain ― the one that covers preventive services and one wellness visit (“physical”) per year with no out-of-pocket costs to patients (no co-pay or deductible charge).
Prevention in health care is the idea that for some diseases (such as breast cancer or HIV) we may be able to prevent devastating illness or death by detecting them early enough to offer the most effective treatment. For other diseases (such as colon cancer or influenza), “prevention” is a test or a vaccine which may be able to avoid the disease altogether. Under the ACA at least 30 different preventive services including laboratory and imaging tests, vaccines, medications and even a genetic test must be covered for appropriate patients at no additional cost. Furthermore, this list of covered benefits is not static, but is structured to evolve as tests or interventions are found to be sufficiently supported by scientific research.
It is estimated that an astounding 40 percent of our now $3 trillion yearly expenditure in health care (the most expensive in the world) is due to preventable illness related to diet, lack of exercise, smoking and excessive alcohol. This massive price tag is only one of many costs which snowball once you consider the opportunity costs of lost wages, family and care-taker resources, not to mention the personal suffering involved. As a primary care physician in one the nation’s largest Community Health Centers, I witness daily the ravages of illnesses that could have been prevented with engagement of people earlier on in wellness and awareness of their own role in avoiding disease. A 2013 Kaiser Family Foundation Survey found that up to 50 percent of adults had put off a recommended preventive service within the previous year due to a concern about cost. This despite the fact that many of them likely did have more access and coverage for that service – under the ACA ― than they were aware. It takes time to re-educate a nation of people who have previously been flummoxed by the vagaries of piecemeal coverage. You don’t need wait to seek care only when you have a concerning symptom; you now have a right (and even a duty) to seek expert advice on how to remain healthy.
Some may complicate this simple message by criticizing the agencies that summarize the scientific evidence that helps to determine which tests will be covered, but those criteria are transparent and based on research conducted generally over many years with diverse populations. Others may say that we still don’t have all the answers about which preventive measures are most effective, but as with any field of medicine, knowledge builds on experience and more data.
There is now a building effort in American health care to engage us all in wellness and disease prevention. The preventive health provision of the Affordable Care Act enables, through complete coverage of these services, a counterbalance to catastrophic care. Now in what appears to be the 11th hour of the ACA, even if you took issue with the partisan way in which the healthcare legislation was passed, you should stand up for the provisions that will save lives and prevent suffering. We must work to preserve access to these services as they may well, in turn, preserve us.