District Court ruling in Texas calls ACA preventive care requirement ‘unconstitutional’
In a ruling that threatens some aspects of preventive care coverage under the Affordable Care Act, a District Court judge in Texas struck down a provision requiring insurers to fully cover preventive services with an “A” or “B” rating under current recommendations from the U.S. Preventive Services Task Force (USPSTF).
Services included in those recommendations include HIV pre-exposure prophylaxis (PReP), certain cancer screenings recommended for early detection, and other preventive care.
According to the ruling, the judge’s reasoning for striking down the law centered on the voluntary makeup of the USPSTF, whose independent members are neither appointed by the President nor confirmed by the Senate. The ability for the volunteer members to make binding recommendations on which services must be covered violates the appointment clause of the U.S. Constitution, the judge concluded.
While finding USPSTF recommendations problematic, the judge did uphold the requirement to fully cover preventive care recommended by the Advisory Committee on Immunization Practices (ACIP) as well as the Health Resources and Services Administration (HRSA). Unlike USPSTF volunteers, the ruling determined that since the Secretary of the Department of Health and Human Services has oversight over these officials, their recommendations do not violate the Constitution’s appointment clause.
The ACIP offers recommendations on preventive immunizations, and the HRSA offers recommendations on preventive screenings for infants, children, adolescents and women. These recommendations are not affected by the judge’s ruling.
The judge also addressed a religious freedom element to the case when making the determination on whether the plaintiffs had legal standing to bring the case, which requires a demonstration of “injury in fact.” Plaintiff Braidwood Management, which offers a self-funded plan for its 70 employees, argued that it holds religious objections to providing HIV preventative medication, which the court upheld as imposing “a substantial burden on religious freedom.”
The new ruling will not take immediate effect, and the Biden administration will have the opportunity to appeal. The next step in the legal process is for the U.S. Department of Health and Human Services and the case’s plaintiffs to file supplemental briefs with proposed remedies.
The American Medical Association has issued a statement in response to the decision, expressing concerns about possible impacts.
“Imposing a copay, high deductible, or any other type of cost-sharing upon patients will deter some of them—and in particular, those of limited means—from scheduling mammograms, colonoscopies, Pap tests, and screening tests for osteoporosis, hypertension, diabetes, lung cancer and other conditions that could shorten their lives if undetected and untreated,” its president Jack Resnick, Jr., MD, wrote in a statement.