A Supreme Court decision with implications for the Affordable Care Act’s coverage of preventive health screenings could “dramatically ⁤change” early detection of ⁢hepatitis C virus, according to research in gastro Hep Advances.

Kennedy v. Braidwood challenges U.S. Preventive Services Task Force recommendations‍ that guide ACA policy, specifically the mandate to cover preventive services, including hepatitis C ‌screening and colorectal cancer screening, without cost-sharing. Medical⁤ societies‌ have urged the court to uphold the mandate.

“We care for people with hepatitis C complications, and while it’s curable,⁤ we’d rather prevent cirrhosis and​ its complications,” said Dr. Elliot⁢ B. Tapper, academic chief of hepatology and associate professor at Michigan Medicine. “Reducing barriers to hepatitis C screening would benefit patients.”

‘A silent disease’

more than 2 million Americans live with ⁢HCV, according to Tapper and colleagues. Prevalence has more than doubled in the last decade and is projected to rise.

Research indicates that 55% to ‍85% of those with acute HCV infection develop chronic disease, and 20% to 25% of those will develop cirrhosis within 25 to ‍30 years.

“Hepatitis‌ C is frequently enough a silent disease,” Tapper said. “It can take 10 to⁣ 30 years to cause liver damage.”

Cirrhosis increases the risk of liver failure and hepatocellular carcinoma, with liver-associated death risk rising to⁢ 4%.

“People with cirrhosis can develop liver cancer or liver failure requiring a liver transplant,” tapper said. “Hepatitis C was once the leading cause of⁢ liver transplant and liver cancer in the U.S.”

Direct-acting antivirals (DAAs) are curative in most cases and ⁢have ‌reduced mortality risk by nearly 43%,saving an estimated $15 ⁤billion in⁢ medicaid costs.

“We can treat liver cancer, but it’s ⁤better to prevent it,” Tapper said.

Costly screening ‘will limit our ability’ for care

Tapper noted that improvements in hepatitis C virus (HCV) testing and treatment have led ⁣to major advancements in disease ‌management.

The USPSTF’s ‌2020 recommendation for one-time HCV screening for adults without cost-sharing​ considerably increased‍ screening rates, the authors wrote.

Screening rates among pregnant women increased from 141 to 253 ⁣per 1,000 person-years,⁢ and among nonpregnant women, ‍rates rose from 29 ​to‍ 37 per 1,000 person-years. In 2022, reported acute HCV infections decreased for the first time ​in over a decade.

“We‌ can now‍ test for and effectively ​treat hepatitis C,” Tapper said. “this has radically changed chronic⁢ liver disease epidemiology in the United States.”

However,screening uptake can still improve.

By reversing ACA coverage mandates, Kennedy v. ⁢Braidwood ⁤ could create new screening barriers, Tapper said.

“Instead of low to no cost, ⁣it will be costly, and patients may decline ​the ​test,” he said. “That will limit our ability to provide effective ⁤preventive care.”

Tapper said the paper aims to⁤ raise awareness of preventive⁣ screening⁣ tests and dispel the belief that HCV screening is “easy.”

“People take it for granted, but if ⁣it’s‌ not covered at⁣ low or no cost, screening won’t be easy. Our​ ability to find at-risk people will diminish.”

Tapper⁤ and his colleagues wrote the paper to highlight the value of HCV screenings and the repercussions of reversing progress.

“We want people to have access ‍to needed health care, including⁢ hepatitis C screening,” he said. “Like colon cancer screening, we want people to ⁣know ​about hepatitis C screening and pressure insurers to‍ cover it.”