Preventive Care After the PrEP Ruling

A Texas judge ruled that the government could not compel private insurance companies to cover the costs of PrEP, a medication that can greatly reduce the risk of HIV infection. The ruling was based on the argument that PrEP is not "medically necessary" for people who are not already HIV-positive. However, many experts believe that this ruling could ultimately hamper efforts to prevent new infections.


On this episode of CareTalk, John and David discuss the broader implications the ruling could have on preventative care. Is it a big deal or is it a nothing burger?


Watch the full episode below:



Here are the highlights from the episode:



Judge rules government can’t compel PrEP coverage under ACA


DAVID :

John, they came at the Affordable Care Act from many different directions, and here is a new one about trying to whack down the coverage of preventive services, in this case, something called PrEP. And that has very specific meaning for some individuals who are on PrEP, which is to prevent HIV, but it may have much broader implications for prevention overall, although some people say it's a nothing burger.


JOHN :

Kelly versus Becerra, another venue-shopping conservative hack job at the Affordable Care Act. But what this is really doing in the shroud of looking of religious freedom, which preventive healthcare doesn't really have anything to do with, and with the patina of anti-gay activity and sort of sexual prudishness that would sort of suggest something from another century, the conservative attack dogs of the legal bar are really starting to chop and chip at the administrative state. And I think what this is, David, in attacking preventive care and claiming that they're worried about religious alternatives, what they're really doing is reducing the scope of preventive care. I mean, David, maybe before you say this doesn't matter, or maybe you could talk a little bit about what preventive care is actually protected under Obamacare.


DAVID :

Well, John, I do think it matters, because there's about 150 million people who are covered under plans that follow the ACA mandates, and that includes prevention. So the specific thing on prevention, John, it refers to something called PrEP, which is preexposure prophylaxis. The idea is basically rather than waiting for someone to get HIV and then treating it, you give the same medication to people that are at very high risk of HIV, so that could be men who have sex with men, it could be sex workers, and it's covered now by the Affordable Care Act. And guess what? It turns out it's 99% effective in preventing HIV and it's just a pretty good payoff considering that it's, you know, it's thousands of dollars a year, but the impact is really great on an individual and even from a cost standpoint. So that's kind of, that's what PrEP is. And then prevention more broadly as you may recall, the Affordable Care Act covers things like cancer screening, so that'd be colonoscopy and mammograms.


It covers smoking cessation, which is a big deal, alcohol abuse counseling, and the list goes on for preventive treatments. And so there has been a major expansion of preventive treatment under the Affordable Care Act that's covered with no copays. This did not use to be the case. So it's a big deal from that standpoint if it affects prevention overall.


| What is PrEP (Pre-Exposure Prophylaxis)?


DAVID :

John, it refers to something called PrEP, which is preexposure prophylaxis. The idea is basically rather than waiting for someone to get HIV and then treating it, you give the same medication to people that are at very high risk of HIV, so that could be men who have sex with men, it could be sex workers, and it's covered now by the Affordable Care Act. And guess what? It turns out it's 99% effective in preventing HIV and it's just a pretty good payoff considering that it's, you know, it's thousands of dollars a year, but the impact is really great on an individual and even from a cost standpoint.


So that's kind of, what PrEP is. And then prevention more broadly as you may recall, the Affordable Care Act covers things like cancer screening, so that'd be colonoscopy and mammograms. It covers smoking cessation, which is a big deal, alcohol abuse counseling, and the list goes on for preventive treatments. And so there has been a major expansion of preventive treatment under the Affordable Care Act that's covered with no copays. This did not use to be the case. So it's a big deal from that standpoint if it affects prevention overall.


JOHN :

But David, under the false flag of religious freedom, these Salem witch trial ideologues are going after promiscuity. I mean, really? The notion that somehow healthcare in any way affects sexual behavior or that the possibility of preventive care would somehow prevent, sort of impede mankind's desire to to bond with its mates strikes me as slightly nutty. But the claims, the specific legal claims here trotting out an extraordinary extension of the Appointments Clause of the Constitution, which is really set up for Ambassadors of Supreme Court, federal court and Supreme Court appointments and Cabinet position.


Somehow that should affect the Preventive Health Care task force in a purely advisory group that provides good clinical baseline for what should be in preventive care. And by the way, as healthcare people, we know that the fastest way to reduce our healthcare costs is actually to invest in the right kinds of preventive care.


To pull out this religious freedom nonsense and to somehow base it in an employer attack on the Obamacare, it's simply a real retrograde attack on healthcare and I guess on modern society. And I think it's just kind of tying itself to these sort of big referenced arguments. It just doesn't make any sense, but what's scary to me, David, is these conservatives that are sort of anti-modern society conservatives are finding a venue in court and a federal judge who is willing to side with that, A, listen, and B, as anyone should, but side with them with some pretty kind of old fashioned backward-looking arguments. I mean, just David, what about this judge, maybe that would give some context here, who has come down in favor of this creative interpretation of the law? Do we have any background on this federal judge?


| Who is Judge Reed O’Connor and why did he rule this way on PrEP?


DAVID :

US district judge Reed O'Connor. So this is the same judge who a couple years ago ruled that the whole Affordable Care Act was invalid based on one point. And who knew it was gonna happen, 'cause the Supreme Court has changed in its trajectory. So I do think, I'm glad you stopped there, John, 'cause I thought you were gonna take us back to the Stone Age as opposed to back to the Civil War era or so, where some of these rulings come from. I do think it's at least fair to entertain what might be the other side of this, to say, okay, you know, maybe I don't want--


John :

Go for it..


DAVID :

PrEP, all right. So even within the community that actually uses PrEP, there is some debate about the wisdom of this kind of approach and what's the messaging. Because you don't want people to increase the risky sex behaviors that had existed before, before HIV and even in the early days of it. And so there is some discussion about it. It's not like it's a totally unfathomable topic. Now, it turns out there's a couple of arguments. One is it actually doesn't cause people to increase their risk really, because nobody actually wants to get HIV--


 

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CareTalk is a weekly podcast that provides an incisive, no B.S. view of the US healthcare system. Join co-hosts John Driscoll (CEO, CareCentrix) and David Williams (President, Health Business Group) as they debate the latest in US healthcare news, business and policy.

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