One of the Affordable Care Act’s most hardcore and hardheaded opponents has finally struck down one of the most consequential and beneficial aspects of the law. On Thursday, Texas District Judge Reed O’Connor ruled that insurance companies are no longer forced to offer free cancer screenings, HIV screenings, diabetes tests, and a number of preventative care options.
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It’s an incredible blow to the ACA, often colloquially branded Obamacare. Under the law, the U.S. Preventive Services Task Force has issued a long list of services insurance companies are forced to cover including everything from breast, cervical, colorectal, and ovarian cancer screenings to HIV tests for both adolescents and adults. There’s also diabetes screenings, vision screening for children, use of statin to prevent cardiovascular disease, STI screenings, medication to reduce the risk of breast cancer—basically a laundry list of services to help keep people healthy and away from expensive hospital visits.
Contraceptive requirements are also covered under the preventative services provisions, though the judge ignored arguments about forcing insurance to offer birth control and other reproductive health care options, at least for now. The Biden administration still has time to appeal, which could put the case to the Supreme Court.
The case revolves around two businesses whose owners argue the preventative care mandate violates their religious rights. In his ruling on Braidwood Management v. Xavier Becerra, O’Connor wrote that the entire Preventive Services Task Force is unconstitutional because it violates the Constitution’s Appointments clause, meaning that public officials need to be voted on by Congress.
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O’Connor had previously struck down ACA provisions that HIV pre-exposure prophylaxis, AKA PrEP pills cannot be covered under Obamacare. Law wonks were quick to point out that this would likely lead to the complete elimination of the preventative services clause. The judge was first elected under President George W. Bush in 2007, but he’s since become the health care law’s main opponent in the courts, routinely trying to invalidate parts or even the entire law, though the U.S. Supreme Court has maintained the broad structure of the landmark 2010 bill.
There’s a good reason this provision exists. Health care and insurance costs have priced out many people from seeking preventative treatment, which goes a long way to saving people from life-threatening diseases and even more expensive costs down the road. Not to mention, the end of the provision is a huge hit to women seeking pregnancy care. Liz Sepper, a health law expert at the University of Texas at Austin, wrote that all of reproductive health care is “on the line.”
The American Medical Association along with a bevy of other health care organizations have regularly told the court it needs to leave the ACA’s zero-cost preventative care provisions intact. The organizations have argued that easy access to preventative care has saved lives, and its repeal would leave even more folks confused about navigating the morass that is the U.S. insurance industry. The AMA’s amicus brief from the end of last year mentioned that doctors “will see many of their patients, including some of their most vulnerable, turn down medically indicated services because of the very financial barriers that Congress sought to remove.”
According to a January 2022 report from the Assistant Secretary for Planning and Evaluation, more than 150 million people with private insurance can receive free preventative services under Obamacare. That also includes people on Medicare and Medicaid. Some individual states still have laws on the books that allow more access to preventative services, though the vast majority, most of the middle-America and southern states, do not.
It is likely that the case will be appealed, and the ruling could be put on pause while the appeal is litigated.