Most people benefit from the ACA's free preventive services

The intersection of clinical and financial health

The report adds to an established body of research that shows eliminating cost sharing leads to greater access to preventive care, researchers from the Milken Institute School of Public Health stated.

Cost remains a top challenge for beneficiaries, and the issue is more pervasive than previously believed. A study published at the end of last year in JAMA Internal Medicine found that nearly a quarter of patients struggled to afford healthcare costs or skipped care altogether.

When beneficiaries skip care, healthcare providers often miss conditions, leading to worse health and more costs later.

The growing popularity of high-deductible health plans has more Americans weighing access against affordability. Employers have also faced rising premium costs, prompting some to shift more of those costs to their employees.

The ACA's preventive benefit coverage guarantee aims to help patients access the care they need to catch costly conditions early, especially in children and older adults.

The report showed that children up to age 9 were the biggest users of preventive medical care, including immunization status assessments. In 2024, nearly 77% of this population received an ACA preventive care service without cost-sharing.

About 66% of people aged 50-64 and 63% of those aged 65+ received a free ACA preventive service.

The ACA's requirement for preventive care coverage boosted access to many services rated A and B by the U.S. Preventive Services Task Force, one of the bodies that determines which services count toward the requirement.

Researchers say USPSTF's work is of "special interest"

The USPSTF has been around since the mid-80s, when the Reagan administration established the group to promote access to high-value preventive health care throughout a person's life. The group received full statutory status in 1999, and the Obama administration later included USPSTF's recommendations in the ACA.

The USPSTF comprises 16 volunteer members who are nationally recognized experts in primary care, prevention and evidence-based medicine and who make recommendations for policymakers and clinicians to influence which preventive services are considered appropriate for patients.

The group is of "special interest" to researchers because its recommendations span the full lifespan. In total, it has issued almost 300 evidence-based recommendations across 90 topics.

However, several businesses and individuals challenged the constitutionality of the USPSTF in a case seeking to vacate the ACA's preventive benefit coverage guarantee. The Supreme Court upheld its constitutionality in 2025; however, the group has not met in over a year, with HHS recently postponing its third consecutive meeting.

The delays in meetings have raised concerns about the group's future under HHS Secretary Robert F. Kennedy Jr., although an HHS spokesperson said the meeting will be rescheduled in the coming months.

Last June, Kennedy fired all 17 panelists of the CDC's Advisory Committee on Immunization Practices, replacing them with seven handpicked members, many of whom are known vaccine skeptics.

The USPSTF is caught in the crosshairs of the ACA fight, in which Republicans generally want to repeal or replace the law. Some conservatives have criticized the group as being too left-leaning, particularly its endorsement of preventive prophylaxis for HIV.

However, researchers said the report "offers compelling evidence regarding the effectiveness of the USPSTF and other ACA-sanctioned advisory bodies in identifying and promoting access to highly beneficial preventive care, and the extent to which people have embraced the opportunity to pursue clinical preventive services of proven value."

HHS has yet to set a date for the next USPSTF meeting.

Jacqueline LaPointe is a graduate of Brandeis University and King's College London. She has been writing about healthcare finance and revenue cycle management since 2016.