GW researchers published a report defending the Affordable Care Act’s preventative services protections amid attempts by President Donald Trump’s administration to weaken the legislation’s provisions.
Researchers said the Democrats of the Senate Committee on Health, Education, Labor and Pensions commissioned the report published in April by the GW Geiger Gibson Program in Community Health, which found the ACA’s preventative services protections — which require most private insurers to cover recommended preventative services like cancer screenings, vaccines and routine checkups — save families more than $4,000 annually in out-of-pocket healthcare costs while reducing the need for more expensive treatment later in life. Sara Rosenbaum, one of the report’s co-authors and emeritus professor of health law and policy at the Milken Institute School of Public Health, said the committee commissioned the report to show how the ACA’s preventative care requirements without cost sharing — out-of-pocket expenses like copays and deductibles — directly reduce household medical spending and expand access to routine care in response to ongoing political efforts to scale-back the ACA’s preventative care requirements.
Rosenbaum said researchers released the report amid concern over conservative efforts to weaken the ACA’s preventative services framework, particularly targeting the U.S. Preventive Services Task Force, which helps determine what services the ACA covers.
“There was a lot of concern that [Health and Human Services Secretary Robert F. Kennedy Jr.] was potentially downplaying the significance of the ACA preventive benefit and preparing to completely scrap the U.S. Preventive Services Task Force,” Rosenbaum said.
The U.S. Preventive Services Task Force is an independent panel of medical and public health experts that reviews scientific evidence and issues recommendations on preventative services like cancer screenings, HIV prevention medication and cardiovascular disease screenings to federal health agencies, including the Department for Health and Human Services. The ACA expanded the task force’s authority by requiring providers to cover preventive services the task force recommends with no cost sharing from patients.
Trump in his first term moved to shorten ACA enrollment periods, reduce funding for programs that help people enroll in ACA health plans and support broader deregulation of federal healthcare programs. Conservative legal challenges have likewise targeted preventative care mandates for covering HIV prevention medication and other services. Kennedy has also postponed multiple task force meetings and reportedly considered removing or replacing members of the panel as part of a broader effort to reshape federal preventive health recommendations.
The Supreme Court in June 2025 voted to uphold the ACA’s requirement that insurers and health plans cover preventive services without cost sharing based on the task force’s recommendations after a lawsuit filed in 2020 claimed members of the task force were improperly appointed.
Rosenbaum said the report shows the ACA’s preventative service requirements and the task force play a central role in both public health outcomes and household cost savings, and weakening its authority, as she warned could occur under recent federal policy shifts, could significantly affect coverage decisions.
“The United States Preventive Services Task Force has been vital to health and vital as a fundamental economic matter to millions of families,” Rosenbaum said.
An estimated 150 million Americans with private insurance benefit from the ACA’s coverage guarantee, and in 2024 alone roughly 100 million patients used at least one ACA-covered preventive service, according to the report. The report also says roughly four in 10 patients still received at least one preventive service even in states with the lowest utilization rates, suggesting widespread uptake across the country.
Rosenbaum said the goal of the report was to evaluate how the ACA’s preventive services protections function in practice, particularly in terms of reducing out-of-pocket costs and expanding access to care.
“In a given year, average families can use enough preventive care so that the savings can be in the thousands of dollars, as opposed to having to go and pay for all these services out of pocket because they’re not covered, or they’re not covered without cost sharing,” she said.
The report found these savings stem directly from ACA requirements that mandate coverage for preventive services without patient cost sharing. It also found when ACA requirements make preventive services free at the point of care, families are more likely to use them regularly, which leads to substantial annual savings that can reach thousands of dollars per household.
Researchers estimated savings using national insurance claims data from FAIR Health — an independent nonprofit that compiles and analyzes billions of commercial insurance billing records from across the United States — and analyzed how often patients use ACA-covered preventive services compared to typical out-of-pocket prices for the same services. They then calculated what families would have paid without the ACA’s coverage requirement by combining real utilization rates with actual service costs from commercial insurance billing records.
Feygele Jacobs, another co-author of the report and director of the Geiger Gibson Program, said the analysis includes estimates of how many people actually use ACA-covered preventive services each year and how those protections translate into real household costs.
“We modeled two different families to understand what their out-of-pocket cost savings could be because of the availability of these preventive care services,” she said. “And it runs in the thousands of dollars a year.”
Beyond cost savings, the report said millions of patients are using preventive services across the country, including over 3.2 million routine women’s health check-up visits, more than 2.3 million hepatitis C screenings and nearly 200,000 genetic tests for inherited cancer risk, alongside large increases in services such as newborn screenings and behavioral health evaluations. This increased use of preventive services leads to earlier detection of diseases such as cancer, diabetes and cardiovascular conditions, which can shift treatment toward less invasive and less expensive care and improve long-term survival outcomes, according to the report.
Jacobs said preventive care has become a central focus in current health policy debates because of its impact on both individual health outcomes and broader population-level well-being.
“It’s really a foundation for better health outcomes, for preventing disease, so that’s important not just at the individual level, but it’s important at the community level,” she said. “It’s important at the population level; it’s really an investment in improving the health and well being for entire communities.”
Andrew Koppelman, a professor of law at Northwestern University, said recent legal disputes involving preventative care requirements under the ACA have largely centered on religious exemption claims involving specific services like HIV prevention medication and vaccines, rather than broad constitutional challenges to preventative care coverage as a whole.
He said these cases often focus on whether employers can opt out of covering services like HIV prevention medication, vaccines or other forms of preventative care on religious grounds, raising questions about how far exemptions should extend under federal healthcare law.
“We are facing a very broad conception of religious liberty that in some cases entails a right to take necessary healthcare away from other people,” he said. “That is, in my view, an exaggerated conception of religious liberty, because, as I understand it, religious liberty is not a right to hurt other people, but I don’t dare predict what the federal courts are going to do.”
