RFK Jr.'s Possible Purge Of Panel On Preventive Care Could Affect You
In a case decided in June, the Supreme Court upheld the authority of the Secretary of HHS to appoint members of the USPSTF rather than requiring presidential nomination and corresponding Senate confirmation hearings and a vote.
The Task Force issues and updates healthcare recommendations on numerous topics having to do with preventive services, including cancer screenings such as mammograms and colonoscopies, but also statins for heart disease, counseling on health behaviors related to weight management, alcohol and drug use, prenatal testing and HIV prevention (preexposure prophylaxis) medications, among many others. USPSTF recommendations affect what kinds of preventive care services, technologies and medicines must be covered at no charge to patients as a result of provisions contained in the Affordable Care Act.
While the Supreme Court ruling preserves the current structure of the Task Force and ensures that its recommendations remain valid, it provides Kennedy with broad latitude to potentially hire and fire the expert panel and reshape what is covered by insurance.
Kennedy's cancelation of a USPSTF meeting in July raises concern that the panel may face a similar fate to what happened to the Advisory Committee on Immunization Practices. Its panel of 17 members was ousted by Kennedy in June and replaced with seven hand-picked members, several of whom share similar vaccine-skeptic views. The ACIP evaluates vaccines and provides recommendations to the Centers for Disease Control and Prevention.
If Kennedy decides to purge the current USPSTF panel he could replace them with members of his own choosing, according to media reports, though it should be noted that HHS says no final decision has been made regarding disbanding the Task Force.
USPSTF has provided recommendations on insurance coverage for preventive services and prescription drugs since 1984. Its 16 members are unpaid experts in prevention and evidence-based medicine who serve four-year terms and have been vetted to ensure no conflicts of interest. Task Force members include independent doctors, nurses and public health experts who volunteer to regularly review scientific research about diseases ranging from cardiovascular conditions to cancer to HIV.
The Task Force assigns grades to their recommendations for medications or procedures: A letter grade (A, B, C, or D grade) based on the strength of the evidence and the benefits and harms of a preventive service. Those with an A or a B grade must be covered by health insurance. This is analogous to what occurs with respect to ACIP's recommendations for vaccines.
The Wall Street Journal reported last month that Kennedy considers the current Task Force to be 'too woke,' apparently referring to past efforts by USPSTF to address 'systematic racism' and health inequalities.
The canceled July meeting was due to discuss diet, physical activity, and weight loss to prevent cardiovascular disease in adults. In light of Kennedy's Make America Healthy Again agenda that aims to prevent chronic disease, these would seem to be topics of concern for Kennedy. Nevertheless, Kennedy called it off, giving no reason for doing so. There is no known plan to reschedule the meeting.
Former Chairs of the Task Force have expressed concern about the entity's future in light of Kennedy's move. They're particularly worried about the 41-year-old Task Force being able to maintain its independence and integrity, should a new panel be appointed that is 'politicized.'
Should disruption to the Task Force occur which results in changes to recommended services and technologies, insurers could correspondingly alter their coverage protocols, possibly removing previously covered items. At the same time, payers may still decide to reimburse unrecommended items if they consider them to be medically necessary or because of the benefits they offer enrollees. There would likely be variation across payer coverage decisions, depending on different priorities that insurers may attach to preventive care services and technologies.
In the case of ACIP, a Wired article suggests that most major insurers haven't confirmed whether they'd continue covering routine shots in instances in which the new committee alters the vaccination schedule. Insurers say they are monitoring any changes the federal government makes to vaccination guidance and will evaluate whether coverage adjustments are necessary.
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