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Texas Judge Strikes Affordable Care Act Preventive Services Requirement
On March 30, Texas-based U.S. District Court Judge Reed O’Connor ordered the federal government to stop enforcing a portion of the Affordable Care Act (ACA) that requires all insurers cover certain preventive care services without patient copays. Judge O’Connor’s March 30 order applies nationwide. Judge O’Connor is not unaccustomed to the ACA. He previously struck down the entire statute before the U.S. Supreme Court reversed his decision and upheld the ACA.

“As President of the American Thoracic Society, I want our membership to know that the ATS is fully aware of this ruling and that we are actively taking steps to oppose the court decision,” said Gregory Downey, MD, ATSF.

In his decision, Judge O’Connor ruled that because members of the U.S. Preventative Services Taskforce (USPSTF) – the body that decides which preventative services must be covered by health insurers - are not appointed directly by the President or confirmed by the U.S. Senate, granting the panel authority to determine covered preventive services is an unconstitutional delegation of Presidential authority. Therefore, requiring health plans to cover the HIV prevention benefits recommended by USPSTF is also unconstitutional. Judge O’Connor further found that the ACA’s requirement for free coverage of HIV prevention drugs “substantially burdens” the religious freedom of a “Christian-owned company” by facilitating a behavior the plaintiff’s religion found objectionable, such as homosexual behavior. Judge O’Connor ruled that the free coverage mandate for two pre-exposure prophylactic drugs (or PrEP), did not “further a government interest” and therefore could not override plaintiffs’ claims of religious discrimination.

The U.S. Department of Health and Human Services estimates that about 150 million individuals with private health plans and 80 million individuals with Medicare and Medicaid have benefited from the preventive care policy struck down by the court. The Biden Administration is expected to seek a “stay” – an order from a higher court blocking implementation of Judge O’Connor’s decision until the ruling can be appealed. It is likely that Judge O’Connor’s decision will eventually be reviewed by the U.S. Supreme Court.
Judge O’Connor’s decision applies to preventive care services like smoking cessation, lung cancer screening, TB testing, as well as adult and childhood vaccines. “Unfortunately, a return of cost-sharing would disproportionately affect those with multiple chronic conditions and underserved communities from getting needed preventive medical care,” says Juan P. Wisnivesky, MD, DrPH, chair, Health Equity and Diversity Committee.
Last Reviewed: April 2023