2025-18
Ensuring Existing Protections for No-cost Preventive Services
Sponsored by
Del. Joseline Peña-Melnyk (MD), Rep. Tara Lujan (NM),
Sen. Gustavo Rivera (NY) and Rep. Geraldo Reyes (CT)
Reported to the Caucus by the
NHCSL Healthcare Task Force
Rep. Alma Hernández (AZ), Chair
Unanimously ratified by the Caucus on November 22, 2025
WHEREAS, in Resolution 2014-05, Addressing Excessive Out-of-Pocket Costs for Patients, the NHCSL called for policies to limit the amount of patient cost-sharing and the need to safeguard affordable patient access to health care services and treatments; and,
WHEREAS, the federal Affordable Care Act (ACA) guarantees access to evidence-based preventive care services, including routine vaccinations, screenings such as for high blood pressure, diabetes, and cholesterol, colonoscopies, mammograms and contraception at no cost for most people who have health insurance; and,
WHEREAS, many states have also passed laws to ensure people with state-regulated insurance can receive preventive care services at no cost;[1] and,
WHEREAS, states have several options to preserve access to zero-cost preventive services, including passing laws to require individual and/or group market plans and state employee plans to cover these services without cost-sharing;[2] and,
WHEREAS, more than 50 million Latinos who get their insurance from employers, Medicare, Medicaid or the ACA marketplace are guaranteed access to these preventive care services, such as cancer screens, children’s check-ups, contraception and other essential preventive care without co-payments or deductibles;[3] and,
WHEREAS, research shows these preventive services protections are associated with an increased likelihood that people who are Hispanic receive recommended preventive services, such as colonoscopies and mammograms;[4] and,
WHEREAS, nearly 6.7 million Latinas ages 15-49 —or 43% of Latinas in that age group— live in the 26 states that have banned or are likely to ban abortion,[5] and Latina maternal mortality is nearly twice as high in banned states as in supportive states;[6] and,
WHEREAS, Hispanics have higher rates of infection-related cancers in America, including cervical cancer,[7] and, as this Caucus highlighted in Resolution 2022-04, Triple-Negative Breast Cancer Awareness, Latinas have larger tumors by the time they are diagnosed with breast cancer in general, all of this reflecting the need for expanding access to routine, preventive care services; and,
WHEREAS, cervical cancer is an infection-related cancer and the HPV vaccine, timely administered in youth, can help prevent it and other HPV cancers;[8] and,
WHEREAS, in Resolution 2019-17, Call for States to Remove Non-Medical Vaccination Exemptions, this caucus underscored the problem of vaccine hesitancy and the need of herd immunity for the best vaccine effectiveness, and in Resolution 2016-04, Adult Vaccine Preventable Disease Awareness and Improvement Month, this Caucus highlighted the needed “ commitment from health care providers and the Department of Health to recommend appropriate immunizations;” and,
WHEREAS, the National Hispanic Medical Association (NHMA) expressed deep concern over the confirmation of Robert F. Kennedy, Jr. as the U.S. Secretary of Health and Human Services (HHS) in part because, “Latino communities already face significant health care disparities, including lower vaccination rates due to systemic barriers, misinformation, and historical distrust in medical institutions,” that the Secretary’s vaccine skepticism exacerbates;[9] and,
WHEREAS, this past Summer, Secretary Kennedy dismissed all 17 members of the Advisory Committee on Immunization Practices, a scientific committee that advises the Centers for Disease Control and Prevention (CDC) on vaccine recommendations, sparking alarm from medical professionals, policymakers and the public;[10] and,
WHEREAS, the Secretary also decided to exclude voluntary liaisons from informing HHS about vaccine recommendations, spurring The American Academy of Pediatrics; the American College of Obstetricians and Gynecologists; the American College of Physicians; the American Medical Association; and the Infectious Diseases Society of America to call the actions “a dangerous step back in protecting patients and public health;”[11] and,
WHEREAS, systemic barriers to healthcare for Hispanics in America result in lower rates of preventive services, such as wellness visits, diabetes screening, blood pressure screening, colon cancer screening and mammograms when compared with rates of access for adults of other races and ethnicities, and efforts to improve access to such care are imperative for the health of Hispanic communities;[12] and,
WHEREAS, even though Hispanics are the ethnic or racial group least likely to have received preventive services, losing access to no-cost preventive services would negatively affect the majority of Latinos who are seeking and receiving this care;[13] and,
WHEREAS, for Latino populations, the California Pan-Ethnic Health Network found that if preventative services such as colorectal and breast cancer screening, flu vaccines, and counseling on smoking cessation and regular aspirin use, were used effectively, around 100,000 deaths could be averted each year. For the cancer screenings, early detection may reduce related death rates by 29%, and every dollar spent on immunizations could save $5.30 in direct health-care costs and $16.50 in total societal costs of disease;[14] and,
WHEREAS, along with the dismissal of experts who help inform HHS entities, President Trump has vowed to repeal the ACA and Congress has so far refused to extend subsidies to ACA premiums,[15] further eroding that law, so the ACA’s mandated no-cost preventive services protections are under threat of possible elimination; and,
WHEREAS, states may be considering how they can help fill gaps in coverage requirements by requiring state-regulated health plans to maintain expansive and comprehensive coverage of preventive health services, and some states, like Maryland and California, have already passed legislation to do so; and,
WHEREAS, a 2022 study analyzing real-world care results of a free clinic in California serving primarily low-income Hispanic patients estimated their services produced $11.5 million in cost savings, in one year by preventing emergency visits and chronic disease complications;[16] and,
WHEREAS, state policymakers can use their power to limit the damage from the dramatic reorientation of federal preventive care services cost-sharing policy by passing legislation to ensure continued access to non-cost preventive services.
THEREFORE, BE IT RESOLVED, the National Hispanic Caucus of State Legislators urges its members and the several states and territories to file and enact legislation to require health insurers to provide no-cost coverage of evidence-based preventive care services; and,
BE IT FURTHER RESOLVED, the National Hispanic Caucus of State Legislators urges its members and the several states and territories to ensure that existing federal and state protections of no-cost preventive services are enforced by the relevant agencies; and,
BE IT FINALLY RESOLVED, that the National Hispanic Caucus of State Legislators calls on Congress and the President to:
- Prohibit the Secretary of HHS from recommending the elimination or reduction of ACA-guaranteed no cost evidence-based preventive care services; and,
- Preserve the entities that make recommendations regarding what preventive services are evidence-based and ensure those entities consist of, and are advised by, people with expertise in the preventive services, not people picked for other reasons; and,
- Restore funding to state, local and territorial governments that is used to ensure people have access to health care providers who can supply preventive services such as screenings, immunizations and contraception.
IN ITS MEETING OF NOVEMBER 13, 2025, THE NHCSL HEALTHCARE TASK FORCE UNANIMOUSLY RECOMMENDED THIS RESOLUTION TO THE EXECUTIVE COMMITTEE FOR APPROVAL.
THE NHCSL EXECUTIVE COMMITTEE UNANIMOUSLY APPROVED THIS RESOLUTION ON NOVEMBER 14, 2025, IN A VIRTUAL MEETING.
THE NATIONAL HISPANIC CAUCUS OF STATE LEGISLATORS UNANIMOUSLY RATIFIED THIS RESOLUTION AT ITS ANNUAL MEETING OF NOVEMBER 22, 2025 IN OKLAHOMA CITY, OKLAHOMA.
[1] Giovannelli, J. et.al., “The ACA’s Preventive Services Benefit Is in Jeopardy: What Can States Do to Preserve Access?” (The Commonwealth Fund, November 21, 2022)
[2] Corlette, S and J Giovannelli, “Federal Court Decision Threatens the ACA’s Preventive Services Benefit: State Options to Mitigate Harm to Consumers,” (State Health and Value Strategies, September 29, 2022).
[3] UnidosUS, “The Affordable Care Act Helps Millions of Latinos Lead Healthier, More Financially Secure Lives”, (March 2025).
[4] Agirdas, C and Holding, J.G., “Effects of the ACA on Preventive Care Disparities,” (Applied Health Economics and Health Policy, 16(6): 859-869; 2018).
[5] Robbins, K.G., C. Gibson, and S. Goodman, “State Abortion Bans Threaten Latinas,” (National Partnership for Women and Families, October 2023).
[6] Gender Equity Policy Institute, “Maternal Mortality in the United States After Abortion Bans,” (Gender Equity Policy Institute, April 2025).
[7] American Cancer Society, “Cancer Facts & Figures for Hispanics/ Latinos 2018-2020,” (2018).
[8] Mayo Clinic, HPV vaccine: Who needs it, how it works.
[9] National Hispanic Medical Association (NHMA), “NHMA Concerned Over RFK Jr’s Confirmation to HHS Secretary,” (February 14, 2025).
[10] Mary Kekatos, RFK Jr. removes all 17 members of CDC's vaccine advisory committee (ABC News, June 9, 2025).
[11] Modern Healthcare, “Blocking physician input on vaccines endangers patients,” (August 15, 2025).
[12] See for example NHCSL Resolution 2021-11 on Improving Care of Atherosclerotic Disease (emphasizing that Hispanics are more likely than non-Hispanic white Americans to have no access to some preventative screening services for that condition).
[13] Dubay L, et al., “Racial and Ethnic Disparities in Preventive Service Use Among Adults Before and During the COVID-19 Pandemic,” (INQUIRY: The Journal of Health Care Organization, Provision and Financing, 2024). See also Alba, C., et.al. “Changes in Health Care Access and Preventative Health Screenings by Race and Ethnicity,” (JAMA Health Forum, February 2024).
[14] California Pan-Ethnic Health Network. “Fact Sheet: Benefits for Latinos of New Affordable Care Act Rules on Expanding Prevention Coverage,” (January 8, 2025).
[15] PBS News, The shutdown deal doesn’t extend expiring health subsidies. What happens to them now? (Nov. 10, 2025).
[16] Dion, A., et. al. “Prevalence of Chronic Disease and Cost Effectiveness of a Free Clinic,” (Journal of Community Health, October 19, 2024).