In the wake of the news

Supreme Court leans toward preserving ACA's prevention mandate. Cancer deaths are declining. Private equity destroys a hospital.

Free prevention services seem safe for now

The Supreme Court is leaning toward preserving the Affordable Care Act’s requirement that private insurers provide highly-rated preventive services free of charge. In oral arguments before the high court yesterday, a majority of justices seemed to support allowing the U.S. Preventive Services Task Force, an advisory board appointed by the Health and Human Services secretary, to continue serving as the ratings arbiter.

Background: The USPSTF, created in 1984 by Congress and reauthorized in 1990 as an independent panel appointed by HHS, gives a letter grade to services like cancer screenings, HIV prophylaxis, and blood pressure control medications. Under the Affordable Care Act, services rated either A or B by the USPSTF must be provided free of charge for the more than 165 million people covered by private health insurance plans.

That mandate’s constitutionality was challenged by two businesses and six Christian conservatives based on the first amendment’s freedom of religion clause. The plaintiffs also claimed the task force violates the Constitution’s appointments clause, which requires the president appoint and the Senate confirm “principal officers” of the United States.

Their real objections stem from the USPSTF giving a high rating to PrEP (pre-exposure prophylaxis pills) to prevent HIV, which they claim would promote behavior they find objectionable like homosexuality and intravenous drug use. Texas federal district Judge Reed O’Connor, a rightwing zealot, ruled in their favor. The ruling was upheld by a three-judge panel in the Fifth Circuit Court of Appeals, two of whom were appointed by Donald Trump during his first term.

During oral arguments in Kennedy v. Braidwood Management before a similarly skewed Supreme Court yesterday, conservative judges all but ignored the religious objections at the heart of the case. Justice Amy Coney Barrett referred to it briefly before dropping the issue.

Instead, they focused on the appointments clause, which was defended by the Trump administration (how ironic). The plaintiffs argued the ACA had created a powerful independent agency, which requires presidential appointment. Principal Deputy Solicitor General Hashim Mooppan told the justices the HHS secretary supervises the task force; he or she has the power to remove members at will; and can review their recommendations and prevent them from taking effect. Congress wanted the benefits that come with an expert body like the task force, but also wanted political accountability, he concluded.

At various points, questioning by justices Brett Kavanaugh and Barrett suggested they agreed with that argument. Justice Elena Kagan summed up those concerns by saying “we don’t go around creating independent agencies. More often we’re destroying independent agencies.” The most likely outcome, most observers agreed in this morning’s press accounts, is that the high court will send the case back to the lower courts for further adjudication.

Latest cancer data proves prevention works

The National Institutes of Health and other agencies reported good news yesterday in the government’s annual report on cancer incidence and mortality. Overall death rates from cancer declined steadily for both men and women between 2001 and 2022. Progress was largely the result of declines in both incidence and death rates for lung cancer and several other smoking-related cancers, NCI researchers reported in the journal Cancer.

In its discussion of lung cancer, the report noted declining smoking rates, earlier detection and better treatments as causes for the declining mortality rate. The American Cancer Society attributes most of the improvement to the public health campaign against smoking, which includes high taxes on tobacco products.

The overall cancer death rate decreased by an estimated 1.3% to 2.1% per year over the two decades and declined more among males than females. But in the most recent five-year reporting period (2018-2022), the annual cancer death rate among men (173 per 100,000) still remained 37% higher than among women (126 per 100,000).

Racial disparities, while shrinking, remain large. African-Americans still have the worst outcomes, dying at a rate that is 10.5% higher than whites. Hispanics have a significantly lower cancer mortality rate. The disparity between men and women is much larger within minority groups than it is among whites. Asian-Americans have the lowest cancer mortality rates.

On the other hand, cancer incidence is rising across-the-board with at least some of it associated with obesity epidemic. Rates of female breast, uterus, colon, pancreas, kidney, and liver cancers are among the fastest growing categories, according to the report.

It will be interesting to look further into the report to determine if they address how much of the increase is due to more screening, where early detection leads to more effective treatment (thus contributing to declining mortality rates). Some critics suggest overly aggressive screening for some types of cancer may simply be padding the incidence rate by identifying pre-cancerous lesions that never lead to full-blown cancer.

Private equity kills two more hospitals south of Philly

The private-equity company that took over four hospitals in Delaware County, PA announced yesterday it will close the last two hospitals in the system within 30 days. The government and attorney general of Pennsylvania has tried fruitlessly for over two years to keep Crozer-Chester Medical Center and Taylor Hospital open.

Prospect Medical Holdings has filed for bankruptcy in the northern Texas bankruptcy court. Thousands of employees who work for Crozer Health received emails on Monday notifying them of the imminent closure. The announcement came despite an offer from Penn Medicine to contribute $5 million to keep the facilities running, which was in addition to the $40 million offered by state and local governments and philanthropic organizations.

Local officials blasted the decision. “Yet again, Prospect decided to put profits over patients by putting Crozer's assets up for auction,” said state Sen. Tim Kearney, who represents the area. Delaware County declared a seven-day disaster emergency as the hospital begins the process of moving patients to facilities in surrounding communities.

Two years ago, I wrote a detailed report on the financial machinations of the private equity firm behind Prospect Medical Holdings, Los Angeles-based Leonard Green & Partners. It walked away with nearly a half billion dollars in profits through sale-leaseback arrangements after the 2016 purchase of the struggling safety net system. When the deal closed, Leonard Green and Prospect Medical Holdings promised to keep the facilities open for at least ten years.

To read that full story, click on this story: