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On March 30, 2023, a judge in the U.S. District Court in the Northern District of Texas issued a final judgment in a court case challenging the Affordable Care Act’s (ACA) requirement that private health insurance plans cover preventive services without cost-sharing for their enrollees. In this judgment, Judge Reed O’Connor held that services recommended by the U.S. Preventive Services Taskforce issued since March 2010 as they pertain to the ACA coverage requirements are unlawful. 

Coverage requirements for vaccines recommended by Advisory Committee on Immunization Practices (ACIP), women’s health services recommended by Health Resources Services Administration (HRSA), and certain services for children and adolescents recommended by Bright Futures, a national health promotion and prevention initiative, are not impacted. The most significant impact for liver disease is on screening for hepatitis B and C, which would be no longer required covered services. Additional impacted services include diet counseling, obesity screening for children and adolescents, and weight loss behavioral health interventions to prevent obesity-related morbidity and mortality in adults. The loss of these services would be detrimental for many people living with liver disease, particularly NASH patients and other patients with specific dietary needs. Plans may choose to cover these preventative services, but they will be permitted to impose cost-sharing. 

The U.S. Department of Justice (DOJ) has already filed an appeal with the 5th Circuit Court. If the 5th Circuit Court affirms the lower court, the case would have to be appealed to the Supreme Court. The DOJ asked a federal district judge in Texas to stay the March 30 decision, vacating the preventive services coverage mandate as the case winds its way through the courts. GLI strongly supports the ACA’s requirement of private plans to cover preventive services and is following this case closely.

This decision, if held in the higher courts, will impact people’s access to care, worsen health inequities, and will end up costing more overall in health care spending. Over time, millions of people could end up paying more out of pocket for preventive services, and many will lose access to certain services altogether. These effects are concerning for all Americans, but are particularly concerning for patients living with liver disease. GLI continues to advocate for equitable policies to prevent liver disease and promote liver health.

Policy Developments at Global Liver Institute

GLI Calls for Robust Engagement of Patients in Implementing the Medicare Drug Negotiation Program

Global Liver Institute joined organizations representing patients and people with disabilities in comments to the Centers for Medicare and Medicaid Services (CMS) calling for robust patient engagement in its implementation of the Medicare Drug Negotiation Program. Three letters, signed by a total of 174 organizations, were sent to CMS. GLI looks forward to being an engaged partner with CMS as the agency negotiates payment for treatments that may impact people with liver disease and liver cancer.

GLI urges cosponsorship of H.R. 2544, Securing the U.S. Organ Procurement and Transplantation Network Act 

The bill is a bipartisan response to the urgent need for reforming the Organ Procurement Transplantation Network (OTPN), breaking up the national monopoly contract so that the HRSA can run an open, competitive process and choose from the best of the best in each field (e.g., health policy, IT, logistics, patient safety), thereby saving more lives.

Donna R. Cryer, JD, founder and CEO of Global Liver Institute and 28-year liver transplant survivor, wrote an opinion piece about this issue alongside other people who have experienced a transplant and whose loved ones are impacted. She testified in 2021 in the House Oversight and Reform Committee in support of bipartisan efforts to make the organ procurement system more accountable. Now that HRSA is moving toward modernization, it is imperative to ensure a truly competitive process that allows HRSA to choose from the best contractors for different national OPTN functions.

GLI Strongly Supports the Nancy Gardner Sewell Medicare Multi-Cancer Early Detection Screening Coverage Act

H.R. 2407 recognizes advances in the fight against cancer by modernizing the Medicare program and creating a benefit category for multi-cancer early detection tests, which allows CMS to initiate an evidence-based coverage process for multi-cancer tests upon FDA approval.

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Further reading: Organ transplants