4 pr eventive services. The judge ruled that recommendations from the USPSTF are unconstitutional because the t A as bou k fo t E rce B iR s a I:n i The E ndepe mnden ploytee , vol Bene untfee it R r p es ane ealr of ch I nns att ii ona tute i l exp s a pr erti s i va n pr te, nonpa eventir on and tisan, nonpr evideo nce fit r -ba esse ear d cm h i ed nst iciitne ute and bas not ap ed poi in Wa nted sh by t ingthe on, D pres .C id .,ent tha a t f nd con ocusefs on h irmed by ealt t h, he S savena ings, r te. etirement, and economic security issues. EBRI does not lobby and does not take policy positions. The work of EBRI is made possible by funding from its members Several Rationales Given for Employers’ Position October 27, 2022, #445 and s If this c poou nsor rt s, whi decisich on i inc s uph lude a eld a br nd t oad hr e c ang over e of age publ mian c, da prtie o vatfe, UfSP or-ST prof F “A it and n ” and “B” onprof riat t or ed s gan eriv za ice tio s i ns. Fo s inval r m ida or te ed, em info prlm oye ati ron g s and he o to al wtw h p wl.eb ans ricoul .org d or i m conne pose s cto w mie th for us on m ofTw cos ittt er sha or ri L ng f inkedI or thes n. e preventive services. Given the Survey respondents gave several reasons for why they would continue to provide these services at no cost to 5 uncertainty surrounding the ACA’s preventive care coverage mandate, we conducted a small pulse survey of members in a follow-up open-ended question. For example, a number of employers commented that covering t A ar T get han ed k Y HRou T decio Me sion m mak be ers rs :t o be This ttst er ud un y w der as st a condu nd how cted t emh prlough oyers the mi EB ght R res I C pond entei rf f to hey we r Resea re rch on He allowed al to th preventive services in full incentivizes their use, promotes better health, prevents more serious conditions, is Will Employers Introduce Cost Sharing for re Bene intrfoduc its Innova e costt s ion har(iEB ng o Rn I C prR eve HB nt I) ive , wse ith t rvh ice f esun . In O ding ct s ober uppor 2022, EB t of the f R oIl conne lowing o cted rg w ani itz h at25 ions em : A plon, B oyers lue Cross insignificant in costs, and saves money in the long term. B repr lue Sh esent iel ing 600 d Asso ,000 e ciation, I mplC oyee UBA s and 1.2 , JP Mor m ga iln C lion cov hase, er Pfi ed l zer ives , and PhR . While our MA. sa mple is not representative of all U.S. Preventive Services? Findings From em ployers, one-half are Fortune 1,000 companies that are often perceived as benefits leaders. Even if the court decision is upheld and the coverage mandate of USPSTF “A”- and “B”-rated services is References EBRI’s First Employer Pulse Survey invalidated, employers may continue to provide these services at no cost to members for at least a few other E Frons mployer tin, P. (2 s Ar 002, Ju e Lik ly e) ly t . Can " o Contin Consum ueer Cove ism" r Slow age the Rate of Health Benefit Cost Increases? EBRI Issue Brief Introduction reasons, including: no.247. When asked in our pulse survey what actions they might take if allowed to reintroduce cost sharing on preventive A recent1. fede Erm alploy judier cia s l op may n inioot n i w n T an exa t to cu s may pu t bene t cov fits dur erage f ing a or ce tir m tai e n w pr hen u evenn tiem ve se ploy rvim ces en tthat is l ar ow e c an ov d ered under Fronstin, P., & Fendrick, A. M. (2021, October). Employer Uptake of Pre-Deductible Coverage for Preventive services in the event of the court decision being upheld, 80 percent of HR decision makers who responded said the Patient Protection and Affordable Care Act (ACA) in question. If that happens, how might employers recruitment and retainment of workers is of concern. they wou Ser ld c viont cesi i nue n H tSA o cov -Eli ergi pr bleve e H nea tive s lth Pl erans vice . s i EB n f RIu I llss . Thi ue Br s was ief, no. true 542 ev.en if they were allowed to impose cost respond? To answer that question, the Employee Benefit Research Institute conducted a pulse survey of Human sha ring. Eight percent would impose cost sharing for at least some preventive services, and 12 percent responded, Resource 2. de T ciher sion e m is p ake rece rs a den ski t ng forhow cove th riey ng m the igh set s res erv po icnd i es w f itthe hou y w t cos ere a t sha llow rin eg d t in o trhe e-iabs ntroduc ence e c ofos thte AC shariA ng o . Whe n n “I Frons t Depe tin,nd P., S s.” epu lveda, M. J., & Roebuck, M. C. (2013, June). Consumer-Directed Health Plans Reduce The preventive services. The sample comprised mostly large employers. The survey was conducted online in early health reimbursement arrangements (HRAs) were introduced in early 2000s, some employers Long-Term Use Of Outpatient Physician Visits And Prescription Drugs. Health Affairs, 32(6), 1126- October 2022. provided first-dollar coverage for specific preventive services (Fronstin 2002). Comparable generous Percentage of Employers That Would Impose Cost Sharing 1134. coverage was implemented when health savings account (HSA)-eligible health plans were introduced for Preventive Services if Allowed by Law Backgroun(d Fron stin, Sepulveda, and Roebuck 2013). Similarly, recent research has found that when the IRS Norris, H. C., Richardson, H. M., Benoit, M.-A. C., Shrosbree, B., Smith, J. E., & Fendrick, A. M. (2021). allowed employers and health plans to cover certain preventive services outside HSA-eligible health Utilization Impact of Cost-Sharing Elimination for Preventive Care Services: A Rapid Review. Medical plan deductibles, about three-quarters of them chose to do so, often without cost sharing (Fronstin and By way of backgr W ound, ould Im w posh e Co en t st S he AC haring A passed in 2010, it included provisions requiring that employers and health It Depends, 12% for Preventive S6 ervices, 8% 1 Care Research and Review, 1-23. plans cover c Fendr ertain pr ick eve 2021) nti.ve s ervices in full. The ACA requires coverage for preventive services without cost sharing if the U.S. Preventive Services Task Force (USPSTF) assigns a letter grade of “A” or “B” to the service. ### In addition to the potential negative clinical and equity effects of restoring cost sharing, from a financial Similarly, Congress turned to the Advisory Committee on Immunization Practices (ACIP) for recommendations on r persp ou ec titn iv e i e, r mm ecun enitza ev tiio de ns a nce s nd t ugg he H estea s tlh th R at the esou im rce plem s an ent d Ser ation vice ofs Adm out-ofi-n pock istraet tio cos n (H tsR w SA ou)l f d hav or rec e a o m mm ini end ma at l ions 7 on w impac om t (e les n’s t s and c han on hie ldr -hal en’ f o s pr f 1 eve pent rce ive nt)se on ag rvices gr.e Igat t is et h em e r pl ec oyer omm hea enda lth ca tion rs f e srpend om tih ng es.e t Mo hree reov groups er, im tha pos t id ng co eterm st in e sharing for clinical services that were previously fully covered would reverse a growing movement among the services that plan sponsors are prohibited from imposing any form of cost sharing (i.e., deductible, copa emply oye men rs ts in r , oec r co ent in y sur eaarnce s to expa ) on w nhen d cov mer em ag be o ersf r cl ece iniive cal tlhes y ef e s fec et riv ve c icesar . The e wit se hout serv deduc ices inc tibllude es or sc copa reeny ings s. Itf a olrs o could hamper intensifying efforts to reduce health disparities for traditionally marginalized groups. cancer and other health conditions, vaccinations, and birth control. The U.S. Department of Health and Human Services has estimated that in 2020, 151.6 million people had access Data and Methods 2 to free preventive care under the ACA. This ACA provision is very popular, favored by 62 percent of 3 Would Not Impose Cost Americans. A recent review reported that removing cost sharing boosts the use of preventive services, reduces We surveyed 25 HR executives, with job titles such as benefits director and vice president of HR, who had Sharing for Preventive disparities, and save Servs l icesi, ves 80% (Norris et al. 2021). at least a moderate amount of decision-making power over the provision of benefits for their firm’s employees. While the sample was small, conducting this survey provides a glimpse into how benefits However, a case before the U.S. District Court for the Northern District of Texas has challenged the requirement executives may approach providing health benefits. Our respondents represented a diverse array of firms that employers must provide coverage for Pre-Exposure Prophylaxis (PrEP) medications that prevent human across a wide variety of industries, each with unique employee populations with their own attendant set of immunodeficiency virus (HIV) without cost sharing. The court concluded that the requirement to cover PrEP challenges and opportunities. Each of the firms we interviewed employed between 350 and 250,000 drugs violates the federal Religious Freedom Restoration Act. workers in the United States, and, in total, these firms accounted for an employee population of nearly 600,000 and covered over 1.2 million lives under their health insurance plans. Collectively, they spent over Source: Employee Benefit Research Institute (EBRI) Pulse Survey of Health Benefits Decision Makers, n=25, Specifically, the decision refers to the part of the ACA that requires preventive services be covered in full related $5.7 billion on he repal resteh ben nting ovef eri 6t0 s 0f ,0o 0r 0 t eh mei plory w eesor . kers and dependents. Though we surveyed a wide cross section to USPSTF ratings. The USPSTF is a group the Agency for Healthcare Research and Quality (AHRQ) has been of employers, the views expressed by our respondents may not be representative of all firms. However, authorized by the U.S. Congress to convene since 1998. The USPSTF has given “A” or “B” ratings to over 50 medium- and large-sized firms tend to be early adopters of changes that eventually propagate through the rest of the market. 4 See https://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics/uspstf-a-and-b-recommendations. 1 Grandfathered health plans are not required to comply with this provision. 5 6 Pulse surveys are short surveys deployed quickly and efficiently. They are designed to solicit data in a way that is not overwhelming to Also see https://ahiporg-production.s3.amazonaws.com/documents/202109-AHIP_HDHP-Survey.pdf and https://www.irs.gov/pub/irs- 2 th h ett su ps:// rve ay sp re e.sp hh os.g ndo en vt. /sit Pe us/d lsee su fau rv lte/y fil s c es/d an o gco u m dee en pts/ in 7t8 o6 afa sp 55 ea c8 ifi 4c e 7 to e3 p8 ic wit 3396h 1 9 a 3 fe 3w t 124 ad rg 70 eted dd2 q /p ure estio venn tis, v e d-e se tec rvt ice tren s-d ib s a -2n 0d 2 2 se .pn dti f.m ent early, and drop/n-19-45.pdf. identify issues for further study. 3 7 https://www.kff.org/health-reform/poll-finding/kff-health-tracking-poll-july-2019/. See https://www.ebri.org/docs/default-source/fast-facts/ff-444-preventiveservices-20oct22.pdf. 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