Affordable Care Act preventive services mandate key to transforming hepatitis C treatment

The pending Supreme Court challenge to the Affordable Care Act’s preventive services mandate has serious implications for the future of treatment of hepatitis C in the United States.

In an article recently published in Gastro Hep Advances, Michigan Medicine researchers describe two potential futures: one in which 90% of hepatitis C cases in the United States are cured within five years and another in which the status quo of insufficient screening rates worsen in the absence of the ACA coverage mandate.

“If the Supreme Court eliminates the preventive services mandate, we risk undoing crucial progress in hepatitis C detection and treatment,” said Jordan Anders-Rumsey, M.D., lead author on the article.

“Without guaranteed access to no-cost screening, more Americans will go undiagnosed and untreated—worsening health outcomes and driving up long-term costs. Preserving the mandate is not just good health policy; it’s a cost-effective step toward eliminating a curable disease.”

Kennedy v. Braidwood Management, Inc. is a pending Supreme Court case challenging the Affordable Care Act’s requirement that health insurance plans cover certain preventive services.

While the impetus for the case is mandated coverage for PrEP HIV-prevention medication, other preventive services with an A or B rating from the United States Preventive Services Task Force could also no longer be covered.

Michigan Medicine physicians have identified a simple one-time hepatitis C screening that received a B rating in 2020 as a potentially affected service.

Hepatitis C is the leading cause of cirrhosis and certain liver cancers.

In the past decade, treatment of hepatitis C has been transformed by direct-acting antivirals, which can cure 95% of cases. 

Researchers cite one 2022 study that found direct-acting antivirals had saved Medicaid $15 billion in avoided health care costs.

“We have a safe and simple cure for hepatitis C, which is effective for approximately 97% of patients if diagnosed before advanced cirrhosis,” said Anna S. Lok, M.D., director of clinical hepatology at the University of Michigan Medical School and co-author of the article.

“This cure has been shown to prevent progression to cirrhosis, reduce the need for liver transplants and decrease liver cancers. But we can only offer cure to infected persons who have been diagnosed.”

Lok calls hepatitis C a “silent killer” as patients are often unaware of their infection until the point treatment is less effective. 

Screening rates for hepatitis C remain, in the words of the article, “unacceptably low in the U.S.”

The authors highlight a national hepatitis C elimination plan that could 24,000 lives and $18.1 billion in healthcare costs over the next 10 years.

Experts fear, however, this opportunity to expand testing and treatment could be lost if the Affordable Care Act’s preventive services mandate is repealed.

Additional authors: Elliot Tapper, M.D., A. Mark Fendrick, M.D.

Paper cited: “The Potential Impact of the Kennedy v. Braidwood Supreme Court Decision on Hepatitis C Diagnosis and Treatment in the United States,” Gastro Hep Advances.  DOI: 10.1016/j.gastha.2025.100722

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