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We must protect the ACA

We must protect the ACA

August 09, 2022

5 min read


Kuwahara reports serving as National Vice Chair of the American Medical Women’s Association’s Policy and Advocacy Committee, National Vice Chair of Doctors for America’s Access to Affordable Care Impact Area, and Co-chair of the Hepatitis B Screening and Vaccine Advisory Council, advocating for expanded access to health care, but the views expressed in this piece are entirely her own. She is a primary care internal medicine physician and health policy fellow and currently serves on the Healio Primary Care Peer Perspective Board.

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Several health provisions guaranteed by the Affordable Care Act have been widely popular among the American people and saved countless lives ever since this landmark piece of legislation was enacted into law.

Despite multiple prior lawsuits and attempts to overturn this legislation, the ACA has so far prevailed. It is, however, now again under threat. Kelley v. Becerra, the latest lawsuit attacking the ACA, is deeply concerning and would directly jeopardize the health of our patients and communities across the nation.

Rita K. Kuwahara, MD, MIH

One of the most important provisions of the act has been ensuring that ACA health insurance plans cover more than 100 preventive health services, screenings and immunizations with no cost- sharing for patients. This guarantees that every person covered by an ACA health insurance plan can access life-saving preventive health care without paying any money out of pocket, including not having to pay any deductibles, copays or coinsurance for covered preventive services provided by an in-network provider.

This provision has enabled millions of Americans covered by ACA health insurance plans to get screened for conditions such as breast, cervical and colon cancer, and receive critical vaccines to protect against infectious diseases such as polio and measles, mumps and rubella without out-of-pocket costs. Access to preventive care is central to maintaining good health and protecting our nation’s public health, as preventing and diagnosing diseases at earlier stages can avoid the high health and economic costs of treating severe complications associated with late disease diagnoses and needing to contain outbreaks of vaccine-preventable infectious diseases.

Kelley v. Becerra threatens to end access to preventive health services without patient cost-sharing for those covered by ACA plans. If this federal lawsuit moves forward, millions of people in the United States will be at risk for delayed and/or missed cancer, heart disease and infectious disease diagnoses and may not be able to financially access critical vaccines, further widening our nation’s existing health inequities, worsening health outcomes, and placing our nation at greater risk for current and future infectious disease outbreaks.

Under the ACA, access to preventive health services without patient cost-sharing benefited more than 150 million people with private health insurance in 2020 and resulted in increased cancer screenings, vaccinations and earlier diagnosis and treatment of chronic diseases such as high blood pressure and diabetes. In addition, the ACA’s guarantee of no cost-sharing for covered preventive services has helped to decrease racial and ethnic disparities in access to preventive care.

Access to preventive care without cost-sharing is essential for the health and well-being of our patients and communities and we must not allow Kelley v. Becerra to end our patients’ access to preventive health services recommended by the U.S. Preventive Services Task Force, the Advisory Committee on Immunization Practices (ACIP), and Health Resources and Services Administration Guidelines. In a statement published by the AMA and co-signed by more than 60 medical organizations, the AMA wrote that “with an adverse ruling, patients would lose access to vital preventive health care services, such as screening for breast cancer, colorectal cancer, cervical cancer, heart disease, obesity, diabetes, preeclampsia, and hearing, as well as well child visits and access to immunizations critical to maintaining a healthy population.”

As a nation, we are still in the midst of the COVID-19 pandemic and monkeypox has just been declared a public health emergency. Now is not the time to repeal access to preventive health care. Rather, we should redouble our efforts to ensure that every person in our nation has access to the care they need when they need it, regardless of financial status, and this begins with access to preventive care, including access to critical vaccines and screenings. As physicians, we must stand up for our patients and demand an end to lawsuits attempting to end access to lifesaving care.

We have made too many recent gains increasing our patients’ access to preventive services in an attempt to improve health outcomes to have Kelley v. Becerra take away our patients’ ability to stay as healthy as possible. Recently updated ACIP guidelines recommending universal hepatitis B vaccination for adults aged 19 to 59 years will be instrumental in preventing hepatitis B virus infection as an issue of health equity. However, if ACA health insurance plans are no longer required to provide ACIP-recommended vaccines with no cost-sharing to patients, our patients with fewer financial resources will be disproportionately affected and unable to access the preventive services they need to enjoy optimal health, resulting in widening health disparities.

In addition, the U.S. Senate has just taken a historic step forward by passing the Inflation Reduction Act of 2022. If this legislation is passed in its current form by the U.S. House of Representatives and signed into law, it will extend for an additional 3 years health insurance premium subsidies for middle class families purchasing health insurance on the ACA marketplace that were originally provided by the American Rescue Plan, and are otherwise set to expire at the end of this year. As we advocate to have this legislation enacted into law, it is critical that we maintain all the provisions in the ACA, including access to preventive services without cost-sharing, to ensure expanded access to comprehensive care.

Continued access to preventive care also represents a critical component of reducing racial and ethnic health disparities. According to the CDC, in the months following the start of the COVID-19 pandemic in early 2020, “declines in breast cancer screening varied from 84% among Hispanic women to 98% among American Indian/Alaskan Native women [and] declines in cervical cancer screening varied from 82% among Black women to 92% among Asian Pacific Islander women.”

Although preventive screenings have subsequently increased since the beginning of the pandemic, an American Cancer Society study based on the national Behavioral Risk Factor Surveillance System published earlier this summer found that in 2020 compared with 2018, “breast cancer screenings decreased more among Hispanic, Asian and Native American women compared to white women [and] the number of Asian and Pacific Islander women who reported completing a breast cancer screening also dropped by 27%, the largest decrease for any race.”

Collectively, these findings highlight the importance of developing an infrastructure grounded in health equity that will provide optimal outreach, resources and support to decrease racial and ethnic disparities in access to essential preventive health services observed during the COVID-19 pandemic.

As we work to eliminate existing health inequities, it is critical that our patients have access to lifesaving preventive care to avoid missed or late cancer diagnoses, provide protection from vaccine-preventable diseases, and enable optimal health outcomes. Our patients’ lives and the health of our nation are at stake, and we cannot allow a lawsuit to overturn one of the most critical components of the ACA. We must, therefore, do everything in our power to protect the health of our patients and our nation by defending the ACA and ensuring ongoing access to preventive health services without out-of-pocket costs for our patients.


Access to preventive services without cost-sharing: Evidence from the Affordable Care Act. Published Jan. 11, 2022. Accessed Aug. 8, 2022.

Democrats passed a major climate, health and tax bill. Here’s what’s in it. Published Aug. 7, 2022. Accessed Aug. 8, 2022.

Millions of women skipped cancer screenings because of COVID pandemic, study suggests. Published June 3, 2022. Accessed Aug. 8, 2022.

Physicians sound alarm on lawsuit threatening preventive care. Published July 25, 2022. Accessed Aug. 8, 2022.

Sharp declines in breast and cervical cancer screening. Published June 30, 2021. Accessed Aug. 8, 2022.

The latest legal challenge to the Affordable Care Act’s preventive services guarantee. Published July 25, 2022. Accessed Aug. 8, 2022.