Sylvia Tayaeend has her blood pressure taken at a free health fair in Los Angeles in May. Thanks to the ACA and an expert task force, blood pressure screenings and other preventive services are also free for patients under most health insurance plans.
Photo by Hans Gutknecht, courtesy MediaNews Group/Los Angeles Daily News/Getty Images
Each year, tens of millions of Americans receive life-saving mammograms, colonoscopies and many other preventive services at no cost, thanks to recommendations from an independent expert panel. For more than 40 years, the panel has played a profound role in shaping the health of the nation, though few U.S. residents have ever heard its name.
Established by the U.S. Department of Health and Human Services in 1984, the U.S. Preventive Services Task Force improves the health of Americans by making rigorous, impartial, evidence-based recommendations for the effectiveness of a broad range of clinical preventive services across the life-span. Though not widely familiar to the general public, the 16-member task force plays a powerful role in guiding what health screenings are recommended, what doctors do during checkups and what services insurance companies cover at no cost based on what actually works to prevent illness, improve quality of life and reduce premature death.
Because it functions independently of political pressure and industry influence, the task force is able to place patients’ well-being and scientific integrity as its highest priorities.
“We set up the task force as an independent body to ensure that the political processes would not intrude upon the scientific considerations,” task force founder J. Michael McGinnis, MD, MA, MPP, senior scholar at the National Academy of Medicine, told The Nation’s Health. “It’s an effort that has proved its merit.”
Although the task force is non-governmental, it wields enormous legal and financial influence through its recommendations on preventive services that primary care providers should offer patients. Such services include routine screenings for high blood pressure, diabetes, cancer, depression and sexually transmitted infections. USPSTF recommendations help focus care on the interventions most likely to save lives and improve quality of life. By issuing regular updates, the task force ensures that recommendations keep pace with the latest research and changing population health trends.
“The task force is viewed as the gold standard in preventive services,” Alina Salganicoff, PhD, senior vice president and director of women’s health policy at KFF, told The Nation’s Health. “It’s really a vast scope of recommendations that basic primary care physicians and other clinicians who offer primary care can recommend to their patients — recommendations that really do make a difference in either prevention or very early identification of high risk, and allow clinicians to really provide mitigating care.”
Every recommendation made by the USPSTF is issued a letter grade of A, B, C or D based on the strength of evidence and the balance of benefits and harms. An I grade is given when there is insufficient evidence to make a recommendation. The transparent and structured approach ensures that preventive services recommended to the public are supported by the best available data.
The Affordable Care Act dramatically increased the power and impact of the U.S. Preventive Services Task Force by linking its recommendations directly to insurance coverage and public health policy. Under the ACA, private health insurance plans must cover, at no cost to the patient, all preventive services that receive an “A” or “B” grade from the task force. That includes cancer screenings, blood pressure and cholesterol checks, depression and anxiety screenings, and tobacco cessation counseling, among dozens of other services.
“Millions of Americans with private health insurance have benefited from this ACA requirement since it went into effect nearly 15 years ago,” Zachary Baron, JD, director of the Center for Health Policy and the Law at Georgetown Law’s O’Neill Institute, told The Nation’s Health.
By requiring coverage without out-of-pocket costs, deductibles or co-pays, preventive services have become more accessible and more widely used since the ACA was signed into law in 2010. For example, after the ACA, screening rates for colon cancer and mammograms increased, particularly among historically underserved populations.
By removing cost barriers, such interventions are not just clinically effective but also socially equitable, said former USPSTF member Steven Woolf, MD, MPH, professor of family medicine and population health at Virginia Commonwealth University.
“We’ve known for decades that financial barriers reduce utilization of these preventive services and disproportionately affect low-income Americans,” Woolf told The Nation’s Health.
Guidelines issued by the task force often become the benchmark for best practice, which makes the task force a major driver of what preventive services are accessible and affordable for more than 150 million Americans each year, most of whom are unaware that an independent, non-governmental panel helped make those no-cost services available to them.
“When the Affordable Care Act was written, lawmakers wanted to ensure that all Americans, especially those at highest risk and least able to pay, could access proven, evidence-based preventive health services without co-payments,” Woolf said.
Court backs expert role of task force
Despite its critical role, the USPSTF has not been well known beyond the health and medical spheres — at least until recently.
On June 27, the U.S. Supreme Court upheld the authority of the task force, rejecting claims brought in a lawsuit by a group of Texas-based business owners. Plaintiffs in Kennedy v. Braidwood Management Inc. had argued that the task force’s role was unconstitutional because its members were not appointed by the president and confirmed by the Senate, and therefore did not have authority to direct which services are covered under the ACA. Fortunately, the High Court did not agree. If it had, access to free preventive screenings would have been lost.
In June, the Supreme Court affirmed the authority of USPSTF to make recommendations on preventive health care services.
Photo by AndreyPopov, courtesy iStockphoto
The court’s decision was widely praised by the public health community.
“The data is clear: When preventive care is free, people use it — and lives are saved,” Rachel Klein, deputy executive director of the AIDS Institute, said in a news release. “Had this decision gone the other way, cost barriers would have returned for services like PrEP, cancer screenings and STI testing, setting back decades of progress. Instead, the court’s decision will ensure that millions of Americans retain coverage for evidence-based, highly effective preventive health care free of cost.”
Even with the decision, the future of prevention services in the U.S. is not ensured, according to Lawrence Gostin, co-faculty director of the O’Neill Institute for National and Global Health Law and founding O’Neill chair. He pointed to recent anti-science decisions made by Robert F. Kennedy Jr., U.S. secretary of health and human services, such as the gutting of a key advisory committee.
“I fear for the future of the USPSTF under a health secretary who does not respect science and has already shown that he will micromanage scientific agencies within HHS,” Gostin told The Nation’s Health.
For more information on the task force, visit https://uspreventiveservicestaskforce.org.
This article was corrected post publication.
- Copyright The Nation’s Health, American Public Health Association
