Many Americans breathed a sigh of relief when the Supreme Court allowed the Affordable Care Act to go into effect following the law. third major legal challenge in June 2021. This decision has left widely supported policy in place, such as providing cover regardless of pre-existing conditionsprovide cover for family members up to the age of 26 on their parent’s plan and delete it limits on annual and lifetime benefits.
But now millions of people in the US are holding their breath again after a ruling of March 30, 2023 in Braidwood v. Becerra it would abolish free coverage for many basic preventive care and medicine services.
Litigation about preventive care
Section 2713 of the ACA requires insurers to offer full coverage of preventive services approved by one of three federal groups: the US Preventive Services Task Force, the Advisory Committee on Immunization Practices, or the Health Resources and Services Administration. If one of those groups recommends preventive care as essential for good health outcomes, then you don’t have to pay anything out of pocket. For example, the CARES lawwhich allocated emergency funding in response to the COVID-19 pandemic, used this provision to ensure that COVID-19 vaccines would be free for many Americans.
For vaccinations, including COVID-19 vaccines, a recommendation from the Advisory Committee on Immunization Practices from the Centers for Disease Control and Prevention, while women’s health services require approval of the Management of health resources and services. Most other preventative services require an A or B rating from the US Preventive Services Task Forcean independent body of experts trained in research methods, statistics and medicine, and supported by the Agency for Care Research and Quality.
The lead prosecutor in the ACA case, Braidwood managementis a for-profit Christian business owned by Steven Hotze, a physician and conservative activist previously submitted multiple lawsuits against the Affordable Care Act. Braidwood and his co-plaintiffs, a group of conservative Christian employers, objected to the requirement to give their 70 employees free access to pre-exposure prophylaxis, or PrEP, a drug that almost 100% effective in preventing HIV infection. Hotze claimed that PrEP “enables and encourages homosexual behavior, intravenous drug use, and extramarital sexual activity between one man and one woman,” despite a lack of evidence to support it. He also claimed that his religious beliefs prevented him from getting insurance that covered PrEP.
PrEP got one A review of the US Preventive Services Task Force in June 2019, paving the way for free coverage for millions of people.
Although Section 2713 of the ACA doesn’t work perfectlysometimes causing patients to become frustrated unexpected billsit has made a huge difference in reducing costs for services such as visit good child And mammogramsto name a few.
More than 150 million Americans are enrolled in private health insurance, which allows them to benefit from free preventive care, with about 60% use at least one free preventive service every year. For example, raising the cost threshold for PrEP again cause disproportionate damage younger patients, people of color and those with lower incomes.
As public health researchers of Boston University And Tulane University who study health insurance And sexual healthwe believe that prevention and health equity in the US will take a major step backwards as these policies come under threat.
Which preventive services are concerned?
The ruling in Braidwood is largely based on the agreements clause of the U.S. Constitution, which states that certain government positions require presidential nomination and Senate confirmation, while other positions have a lower bar.
Texan Federal District Judge Reed O’Connor ruled that because the US Preventive Services Task Force is an independent volunteer panel and is not made up of US government officials, they do not have the proper authority to decide what preventive care should be free, unlike the Advisory Committee on Immunization Practices or Management of health resources and services. O’Connor also ruled that being forced to cover PrEP violated plaintiffs’ freedom of religion.
Following his initial ruling in September, both parties filed briefs attempting to provide the “cure” or solution that the judge would eventually recommend. He could have chosen, if the federal government pleaded, to grant only plaintiffs an exemption from covering PrEP under the Restoration of Religious Freedom Act. But O’Connor chose instead to apply his “cure” nationally and cover more services.
He invalidated all of the task force’s recommendations since the Affordable Care Act was passed in March 2010, which once again gave insurers and employers the power to decide what preventive care, if any, would remain free for patients in their plans. A few of the recommendations fall under his ruling including PrEP; screening for blood pressure, diabetes, lung and skin cancer; and medications to lower cholesterol and reduce the risk of breast cancer. From 2022, 15 states have laws with ACA-like requirements for plans in the insurance market, but not for major employer plans in general exempt from state supervision.
Insurance contracts are usually defined by calendar year, so most people will see these changes will not start until 2024. Importantly, these services will probably still need to be covered by health insurance essential health benefits via a separate provision of the ACA – they just won’t be free anymore.
Other recommendations from the US Preventive Services Task Force and those of the Advisory Committee on Immunization Practices of Health Resources and Services Administration — namely immunizations and birth control, respectively — remain free to patients for now.
The federal government appealed the ruling of the 5th US Circuit Court of Appeals on March 31, 2023, supported by a coordinated response of 23 patient advocacy groups. They have asked for a stay while the case continues, interrupting the effects of the ruling. If O’Connor or a higher court grants their request, the status quo of free preventive care will remain.
But there are also concerns that either the 5th Circuit or the Supreme Court could push the ruling even further, jeopardizing the free coverage of birth control and other preventive care that remains in effect.
Portions of this article originally appeared in previous articles published on September 7, 2021, December 1, 2021, and September 13, 2022.