Topline
A federal judge in Texas struck down a provision of the Affordable Care Act that required coverage for a range of preventive services—including for cancer screenings, medications and more—ruling the task force members tasked with enforcing those preventive services were unlawfully appointed.
A demonstrator holds a sign in front of the US Supreme Court in Washington, DC, on November 10, ... [+]
Key Facts
U.S. District Judge Reed O’Connor ruled preventive care recommendations made by the U.S. Preventive Services Task Force do not have to be complied with, and blocked the federal government from enforcing the task force’s recommendations.
The task force issues recommendations for preventive care services that insurers are then forced to cover, as dictated by the provisions of the Affordable Care Act, meaning the ruling means insurance companies will no longer be bound to cover the preventive services affected.
Among the preventive services affected by O’Connor’s order are screenings for breast cancer, colorectal cancer, cervical cancer and lung cancer, diabetes screenings, various screenings and interventions for pregnant people, statin use to prevent cardiovascular disease, vision screening for children and more.
O’Connor had already ruled in September that HIV pre-exposure prophylaxis (PrEP) pills should not have to be covered under the ACA, ruling that its coverage violated the religious freedom rights of the Christian-owned company that brought the lawsuit, but his ruling at that time did not concern other preventative services.
The judge did throw out other arguments that tried to invalidate the contraceptive mandate in the ACA, so coverage for contraception will remain unaffected by Thursday’s ruling.
What To Watch For
The Biden Administration is expected to appeal O’Connor’s ruling, which means there’s still the possibility a higher court could overturn it. Insurance coverage contracts generally run through the end of the year, making any changes to insurance policies and what services they cover unlikely before 2024. That means if the case is reversed when it’s appealed, there ultimately could be little impact to Americans’ coverage—though it still remains to be seen how higher courts, including potentially the Supreme Court, will respond to the case.
Chief Critic
More than 60 health organizations, led by the American Medical Association, issued a joint statement in July warning about the potential ramifications of a ruling from O’Connor that struck down the preventive services mandate. “Our patients cannot afford to lose this critical access to preventive health care services,” the statement said. “Rolling back this access would reverse important progress and make it harder for physicians to diagnose and treat diseases and medical conditions that, if caught early, are significantly more manageable.”
Big Number
More than 150 million. That’s the number of Americans with private insurance who have coverage for preventive services under the ACA, the Department of Health and Human Services reported in January 2022, along with approximately 20 million Medicaid and 61 million Medicare beneficiaries.
Surprising Fact
This isn’t O’Connor’s first major ruling concerning the ACA, as the judge—a George W. Bush appointee—also invalidated the ACA in its entirety in 2018, striking it down as unconstitutional. That ruling was ultimately overturned by the Supreme Court.
Key Background
The ACA, also known as Obamacare, has been a frequent legal target from the right since it was enacted in 2010, and the Supreme Court has now upheld the law three times on separate occasions. The lawsuit at issue in Thursday’s ruling was first filed in 2020 by plaintiffs including Christian business owners who objected to paying for services like contraceptives on religious grounds, as well as individual health insurance customers who argued they didn’t want to pay for preventive care they weren’t using. The suit was led by attorney Jonathan Mitchell, who is also known for his role in helping devise a Texas abortion ban that allowed private lawsuits against anyone who “aids or abets” an abortion. O’Connor’s ruling in September found that PrEP violated the companies’ religious freedom and that the task force should not have added the drug to its list of preventative services, but the ruling did not fully resolve the case or have any binding effects at that time, with the judge calling for more briefing on the full scope of the case and what plaintiffs wanted in terms of relief.
Further Reading
Federal Judge Rules Companies Should Not Have To Cover PrEP HIV Prevention Medicine (Forbes)
Physicians sound alarm on lawsuit threatening preventive care (American Medical Association)
Court ruling on HIV meds could have sweeping implications for preventive care (Axios)
