Texas Judge Strikes down ACA’s Free Preventative Care Requirement

Yesterday, a federal judge in Texas struck down a key provision of the Affordable Care Act (ACA) requirement that insurers and employers cover free preventative screenings for cancer, heart disease, HIV, and other illnesses. The decision, which applies nationwide and takes effect immediately, threatens access to these services—which include mammograms and STD testing—for more than 100 million Americans.

Judge Reed C. O’Connor of the U.S. District Court for the Northern District of Texas—who previously struck down the entire ACA law before it was upheld by the Supreme Court—granted Braidwood Management Inc.’s request to block an ACA requirement for cost-sharing coverage of preventative services.

The ruling invalidates nationwide zero-cost-sharing coverage requirements of preventative services recommended by the U.S. Preventive Services under the Affordable Care Act and finds that required coverage of PrEP for HIV violates the Religious Freedom Restoration Act. Cost sharing will likely deter patients from scheduling some of these procedures.

The Ruling’s Reach

This ruling won’t impact every preventative screening, as some recommendations predate the ACA, which was signed into law in 2010. However, the case could have long-term implications for millions of people who are covered by private insurance, according to the Kaiser Family Foundation.

Since 2010, more than 2,000 legal challenges have been filed in state and federal courts contesting part or all of the law. Yesterday’s case, Braidwood Management v. Becerra, involved the ACA’s requirement that most private insurance plans cover specific preventative care items and services, such as contraceptive care and supplies, and cancer screenings. Two Christian-owned businesses and six individuals in Texas challenged the legality of the preventative care mandates on constitutional grounds. The plaintiffs also challenged the requirement to cover medication to prevent HIV, based on religious grounds.

In September 2022, Judge O’Connor ruled partly in favor of the plaintiffs and partly in favor of the Department of Health and Human Services (which defended the ACA).

While not surprised by Judge O’Connor’s decision, Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, said, “It is imperative that these critical preventive services must continue for the health of our nation. We expect that the U.S. government will quickly act to stay this decision, so that preventive services can continue nationwide, and appeal it. Preventive services are all critical and well-established medical services. … While the appeals process moves forward, we call on health insurers to act on their own and continue to cover these preventive services without cost-sharing for the benefit of their enrollees.”

As a result of the ruling, “the government may no longer be able to require insurance plans to cover certain preventive services and items at no cost to patients. Insurers and employers would once again have discretion over whether to cover preventive services, resulting in lower premiums in some cases but also a patchwork of coverage,” according to the Kaiser Family Foundation. “Any rollback of the government’s ability to enforce these requirements could impact the millions of people covered by private insurance. The outcome of this case could also have broader ramifications for the authority of federal agencies to address a wide range of issues through regulation.”

It is likely that the Biden administration will appeal the ruling. Kaiser Family Foundation officials maintain that Braidwood Management v. Becerra has the potential to reach the U.S. Supreme Court.

From: BenefitsPRO