The American College of Chest Physicians (CHEST) opposes the federal court’s March 30, 2023, ruling in Braidwood Management Inc. v. Becerra and applauds the Department of Justice for acting so swiftly to appeal this decision. The court's remedies strip the guarantee of no-cost preventative benefits away from the 151 million people insured by the Affordable Care Act (ACA) and currently have access to care, such as smoking cessation services, guideline-indicated lung cancer screening, and tuberculosis testing.
“CHEST’s mission is to champion the prevention, diagnosis, and treatment of chest diseases with prevention paradoxically facing the most barriers. Creating awareness among patients and advocating for measures that impede and inhibit serious disease from taking root offers the highest potential for improving public health and curbing healthcare spending,” says Doreen Addrizzo-Harris, MD, FCCP and President of CHEST.
If this ruling stands, preventive care becomes a privilege based on socioeconomic status when we already know tremendous disparities exist in health care. While health services research has found many factors for this, access and cost routinely top the list. This ruling will widen this gap further and undo years, perhaps decades, of progress.
“We know what happens when you add a cost burden to things like lung cancer screening. People opt out. They miss an opportunity for early detection and improved survival rates,” added Dr. Addrizzo-Harris. “At a time when our community is intensely focused on eliminating the stigma of lung cancer and expanding care like screening and cessation to historically marginalized people, this decision is poised to remove years of progress. The Biden Administration’s Cancer Moonshot will fail those most at risk.”
The ruling asserts that the ACA cannot require coverage for the recommendations developed by the U.S. Preventative Services Task Force (USPSTF) because they are not empaneled in accordance with the Appointments Clause of the Constitution, which requires appointment by the President and Senate confirmation.
CEO Robert Musacchio, PhD elaborates: “As an organization that puts great care into managing CHEST panelists’ conflicts of interest in our guideline process, we assert that what the court has suggested allows politicians to introduce substantial conflicts. CHEST invests a substantial amount of resources and effort creating evidence-based clinical practice guidelines following a methodology similar to the USPSTF. We are appalled at the attempt to insert politics between clinicians and their patients further.”
The CHEST 2021 lung cancer screening guidelines align with the USPSTF, and the CHEST Tobacco Dependence Toolkit is a key resource for providers along with cessation and screening programs.
“Unfortunately, the impact of this decision extends far beyond the patients served by our membership, with a detrimental impact on mental health services, maternal health, child development, heart disease, the proliferation of sexually transmitted disease, and more,” says Dr. Musacchio. “As such, CHEST will work with the broader medical community, advocacy groups, and policymakers to ensure the public has equitable access to the services that will improve and sustain their lives.”
CHEST strongly urges the court to reverse this decision and asks employers and insurers to support and continue life-saving, first-dollar coverage for preventative services.