How an ideological war over PrEP threatens preventive services from smoking cessation to contraception to vaccines for half the U.S. population



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Healthcare in the United States is notoriously complicated. In the absence of comprehensive national coverage, most Americans have employer-sponsored insurance. It is by far the most common source of health benefits in the U.S., with nearly 75% of working adults (and half of our nation’s children, as dependents) receiving health coverage from their employers.

As a player in the employer-sponsored healthcare space, we see firsthand the care, energy, and dedication that human resource and benefits teams at leading companies across the country have for their employee’s well-being. We’ve seen benefit teams make mid-year plan changes to provide better support during the pandemic, aim to do better than the status quo, and center health benefits in their people strategies.

More than anything, we see companies trying to nudge their employees into the lowest-cost, highest-reward behavior: prevention. This is a great strategy. One of the best ways for employers to support their employees and their families—while keeping an eye on costs—is by prioritizing and promoting preventive care.

The return on investment might take longer, but preventive care is critical for population health. Preventive services can help identify illnesses or risks earlier, manage care more effectively, and treat issues before they develop into more complicated, debilitating, and expensive conditions. Even if you’re looking at your health benefits strategy from a purely dollars-and-cents perspective, prioritizing preventive coverage just makes sense.

And while it’s always been a cost-effective and compassionate decision for employers to invest in their workforce by offering preventive care and services, it wasn’t until the Affordable Care Act (ACA) was passed in 2010 that employers were actually compelled to provide these benefits.

Since its passage, the ACA has required employers to cover certain preventive services without any cost-sharing like copays, coinsurance, or deductibles. More than 150 million Americans now have access to preventive services—and these are popular across the political spectrum: Polling shows that 80% of Democrats and 50% of Republicans support this provision of the ACA.

However, Braidwood v. Becerra, a case recently decided by the Fifth Circuit Court of Appeals and likely headed to the Supreme Court, is trying to chip away at the most popular, affordable, and impactful parts of the ACA.

Last year, Texas-based federal Judge Reed O’Connor moved to block the requirement for employers to offer certain zero-cost preventive services, including programs to help people quit tobacco products, HIV prevention medication coverage, and preventive screenings for anxiety, hypertension, and hepatitis B and C. The decision was appealed by the federal government. 

The Fifth Circuit upheld the national requirements for now, saying the lower court went too far on that front. However, the court agreed with the plaintiffs that the members of the U.S. Preventive Services Task Force, an independent panel of experts staffed by the Department of Health, should instead be nominated by the president and confirmed by the Senate. The Fifth Circuit called on the lower court to challenge the constitutionality of the federal agencies that recommend preventive services like vaccines and care for women and children. The ruling narrows the scope of the case—but sets a dangerous precedent for others looking to strip coverage for preventive services, and leaves preventive service coverage at risk.

The real focal point of this ruling was Pre-Exposure Prophylaxis (PrEP), a highly effective HIV prevention medication and a key part of the national plan to fight HIV in the U.S. This appears to be a targeted attack on PrEP on ideological grounds, and the ruling not only ignores science but also erodes decades of public health gains. Numerous studies from around the world have shown that PrEP programs effectively prevent HIV—saving lives and preventing costly care.

This case goes even further by challenging the authority of the U.S. Preventive Services Task Force and could impact the cost-sharing of other important services like hepatitis screenings. By catching and treating this disease early, people (and their employers, who will shoulder the cost) can avoid devastating liver failure and its many complications like transplants, multiple medications, repeated hospitalizations, and follow-ups for the rest of their lives. 

So much pain, disruption, and costly care can be prevented by routine screenings and effective treatment. And yet sometimes the simplest and most valuable steps, like routine screenings, can be the hardest to take. Understanding, accessing, and actually using health insurance is incredibly confusing, and when there’s a cost barrier in the way, it can keep people from accessing the care they need. It’s just hard to be a savvy shopper in our current healthcare landscape. Which is why it’s even more important to ensure the right choice is the easiest one to make. The more we can remove barriers to preventive care, the better.

If you’re an employer looking for the secret to low-cost, high-impact ways to recruit and retain talent while fostering a healthy and productive workforce, prioritize preventive healthcare coverage and remove barriers like copays, coinsurance, and deductibles.

True wellness requires preventive care. We’re calling on employers, HR, and benefit administrators to look past the legal and political battles and to keep doing what you’ve been doing. Prioritize zero-cost preventive care for your employees and their families. You will be rewarded with a healthier team and a healthier bottom line, today, tomorrow, and for years to come.

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The opinions expressed in Fortune.com commentary pieces are solely the views of their authors and do not necessarily reflect the opinions and beliefs of Fortune.



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