A federal judge invalidated an Obamacare requirement that most private health insurance plans must offer free preventative care, including everything from screens for specific cancers and diabetes to HIV prevention medications, on Thursday (March 30, 2023).
The ruling by Judge Reed O’Connor of the U.S. Northern District Court of Texas applies to medication, screenings and other forms of health care recommended by an independent panel of experts called the Preventive Services Task Force.
Private health insurance plans had to include coverage for colon, cervical, and lung cancer tests as well as mammograms for women aged 50 to 74 under the Affordable Care Act.
Pre-exposure prophylaxis, or PrEP, medications that prevent HIV infection in high-risk individuals were also covered by the mandate. The majority of private plans were also required to provide coverage for tests for certain STDs like chlamydia and gonorrhea.
The Obamacare requirements also covered screenings for Type 2 diabetes, among numerous other forms of preventive health care.
O’Connor in the same ruling Thursday rejected an argument by the plaintiffs to also overturn the mandate that requires Obamacare-compliant plans to cover birth control with no out-of-pocket costs.
Some 150 million Americans had access to free preventive care under the Obamacare requirements, according to the Health and Human Services Department.
Lawrence Gostin, a leading health law expert, said full coverage of these essential services with no out-of-pocket costs is now in jeopardy.
Preventive care is an essential part of health care: it saves lives, saves families money, and improves our nation’s health. Actions that strip away this decade-old protection are backwards and wrong.
Kamara Jones
“The big picture is crystal clear. Virtually everything Americans have come to rely on to keep themselves and their families healthy and to prevent disease is no longer going to be required under the Affordable Care Act,” said Gostin, a professor at the Georgetown University Law Center.
The Biden administration is likely to appeal the ruling. Kamara Jones, a spokesperson for Health and Human Services, said the agency is consulting with the Justice Department on next steps in the litigation.
“Preventive care is an essential part of health care: it saves lives, saves families money, and improves our nation’s health,” Jones said. “Actions that strip away this decade-old protection are backwards and wrong.”
Senate Majority Leader Chuck Schumer, D-N.Y., called on the Biden administration to appeal the ruling immediately. He also called on insurers to publicly commit to providing free preventive care.
“This ruling is not only misguided, it is outright dangerous and could cost lives,” Schumer said.
Gostin said most private insurance plans will probably continue to cover these preventive health-care services but charge deductibles and copays.
“It will primarily affect working-class Americans,” he said, noting that many people will forgo essential health care because they can’t afford the out-of-pocket costs.
O’Connor’s ruling said that coverage requirements based on recommendations from the Preventive Services Task Force are unlawful because members of the panel were not nominated by the president and confirmed by the Senate. Therefore, the federal government cannot enforce a coverage mandate based on those recommendations, he said.
The Preventive Services Task Force is made up of 16 volunteers who are doctors, nurses, public health experts and other medical professionals. The director of a federal organization called the Agency for Healthcare Research and Quality appoints them.
After being sued by a number of people and two Christian businesses in 2020, the court issued his decision. In that complaint, the plaintiffs claim that the preventative care mandate violates their right to exercise their religion because it covers medications that help people avoid contracting HIV.
The plaintiffs claim in their suit the PrEP mandate “forces religious employers to provide coverage for drugs that facilitate and encourage homosexual behavior, prostitution, sexual promiscuity, and intravenous drug use.”
They also claimed the Preventive Services Task Force’s recommendations are invalid because the process used to select the body’s members violates the U.S. Constitution’s Appointments Clause.
