No-cost preventive care has been a pillar of employee benefit plans since the Affordable Care Act (ACA) mandated coverage. Taking advantage of routine preventive services helps employees contain long-term health care spending, yet no-cost care remains widely underused. Demystifying how covered services are designated boosts understanding and puts meaning behind the recommendations.
With roughly 150 million individuals enrolled in subject employer-sponsored health plans, the determination of covered preventive services is a weighty undertaking. Under ACA rules, the federal Advisory Committee on Immunization Practices provides vaccination recommendations, and the Health Resources and Services Administration provides recommendations for women’s and pediatric health-based services. Other inclusions for the no-cost preventive services package come from the U.S. Preventive Services Task Force (USPSTF). The USPSTF aims to improve health on a nationwide level. After a multistep development process, the advisory task force provides evidence-based recommendations for which preventive health services, like screenings and medications should be provided in primary care settings. Recommendations are given grades, and those with A or B designations are adopted as no-cost preventive services for applicable health plans.
The Agency for Healthcare Research and Quality (AHRQ) provides support to the USPSTF. The AHRQ seeks to uphold the task forces’ integrity by screening members and implementing safeguards to ensure no outside interests or bias influence a member’s decision making.
Members of the USPSTF must be independent, free from political pressures and have expertise in preventive medicine and primary care. After volunteering for a seat on the panel and passing the screening process, members are appointed by the Secretary of Health and Human Services (HHS).
Concerns over the legality of USPSTF selection and confirmation processes have been brought to the U.S. Supreme Court. The Fifth Circuit U.S. Court of Appeals previously ruled that the task force is unconstitutional, calling for all recommendations since 2010 to be invalidated. If the Supreme Court rules in favor of overturning the USPSTF recommendations, employer preventive service coverage would be impacted.