Right now, the ACA requires a lot of preventive care to be covered with no cost-sharing.  This legal requirement is intended to reduce the barriers to accessing care that likely has substantial long term value but little short term value that can be captured by insurers.  However, ACA opponents have sued to have this requirement be rendered moot as they contend that the Department of Health and Human Services overly relies on a non-executive branch board to declare what services are required to be no cost sharing.

The likely dire consequences if Texas Judge O’Connor and his conservative judicial colleagues strike down the ACA’s required first-dollar coverage for preventive services.https://t.co/2dVMuZv3gm

— Harris Meyer (@Meyer_HM) March 8, 2023

We have an incentive issue.

Right now, insurers cover these services because they have to.  The judge might remove the have to.  If there is no change in incentives, there is a legitimate fear that a lot of policies will stop offering no-pay preventive care services. And once that happens, uptake for vaccinations and screenings will collapse because price is a major barrier for some populations and preventive care service utilization when there are cost-sharing requirements is an excellent predictor of higher than expected/risk adjusted utilization.

There is a way to make preventive care services a “want to” offer service rather than a “have to” offer service.  Incorporating procedure codes associated with these services into the risk adjustment formula would create financial motivations for insurers to aggressively deliver these services.  Risk adjustment in the ACA is zero sum, so insurers that pay for a lot of these services will get money from insurers that don’t pay for a lot of these services.  Conversely, insurers that place a lot of barriers to accessing  preventive care will be paying other insurers.  On a first blush static analysis, this should have minimal, if any premium impact, but rejiggering incentives by changing risk adjustment is a first pass plausible policy response to this lawsuit.