Mammogram screening to detect breast cancer.
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Health and Human Services Secretary, Robert F. Kennedy Jr., is overhauling the United States Preventive Services Task Force. Calling it “lackadaisical,” Kennedy dismissed top leaders of the independent group of experts two weeks ago. This followed a series of meeting cancellations and unfilled vacancies in the past year or so. Public health experts have warned about the possible negative impact an upheaval could have on coverage of preventive care screenings by health insurers. This is because the task force recommends evidence-based preventive care, which then must be covered by insurers with no patient cost-sharing under a provision in the Affordable Care Act. According to KFF, this ACA provision may be the one that has affected the largest number of Americans.
The USPSTF has provided recommendations on insurance coverage for preventive services and prescription drugs since 1984. Its members are unpaid experts in prevention and evidence-based medicine who serve four-year terms and have been vetted to ensure no conflicts of interest. They include independent doctors, nurses and public health experts who volunteer to regularly review scientific research about diseases ranging from cardiovascular conditions to cancer to HIV.
The group evaluates preventive healthcare services and technologies and subsequently issues and updates recommendations related to a wide array of treatments. Among others, this includes cancer screenings such as mammograms and colonoscopies, HIV prevention (preexposure prophylaxis) medications, counseling on health behaviors related to weight management, alcohol and drug use, prenatal testing and statins for cardiovascular health.
The task force assigns grades to their recommendations for medications or procedures: A letter grade (A, B, C, or D grade) based on the strength of the evidence and the benefits and harms of a preventive service. Those with an A or a B grade must be covered by health insurance in both the public and private sectors.
Kennedy fired two vice chairs of the panel last month, framing the removals as a necessary measure to replace them with people who share a “clear mission.” It’s unclear what this means. But perhaps it relates to what the Wall Street Journal reported last year when the newspaper said Kennedy considered the task force “too woke,” apparently referring to past efforts by USPSTF to address “systematic racism” and health inequalities.
We first caught wind that Kennedy was going to uproot the advisory panel when he abruptly canceled a scheduled meeting last summer. Interestingly, the canceled get-together was due to discuss diet, physical activity and weight loss to prevent cardiovascular disease in adults. In light of Kennedy’s Make America Healthy Again agenda that aims to prevent chronic disease, these would seem to be topics of concern for Kennedy. Nevertheless, he called it off, giving no reason for doing so.
The sacking of key leaders of the panel raises concern that the entire group may face a similar fate to what happened to the Advisory Committee on Immunization Practices. Its panel of 17 members was ousted by Kennedy in June and replaced with hand-picked members, several of whom share similar vaccine-skeptic views. The ACIP evaluates vaccines and provides recommendations to the Centers for Disease Control and Prevention. In turn, health insurers must take CDC advice into account in their coverage decisions.
It’s unknown if and when a new panel will take shape. It would seem likely that Kennedy would replace the entire panel with members of his own choosing, as he did with ACIP.
Long before the dismissal of the two vice chairs in May, former leaders of the task force expressed concern about the entity’s future in light of Kennedy’s moves. They’re particularly worried about the 42-year-old task force being able to maintain its independence and integrity, should a new panel be appointed that is “politicized.”
The uncertainty caused by all this has resulted in disruption of the panel’s day-to-day operations. The group had been working recently on draft guidelines for alcohol screening, cervical cancer self-swabs, perinatal depression and vitamin D supplementation. The fate of this guidance is uncertain. More importantly, the disruptions may eventually reshape which preventive care services and technologies are covered by insurance.
Insurers could alter their coverage protocols, possibly removing previously covered items. This said, payers may still decide to reimburse unrecommended items if they consider them medically necessary or simply because of the benefits they offer enrollees. At the same time, there could be variation across payer coverage decisions, depending on different priorities that insurers may attach to preventive care. This in turn would undermine the purpose of the ACA provision, to ensure universal access to preventive care.