'Stripping away care': Judge rules ACA preventive services requirement unconstitutional

Key takeaways:

• A federal judge ruled that the mandate for insurers to cover certain preventive services at no cost cannot be enforced.
• Medical organizations said the ruling will jeopardize health care access for millions.

Medical organizations are sounding the alarm after a federal judge ruled that it is unconstitutional to require insurers and health plans to cover preventive services recommended by the U.S. Preventive Services Task Force at no cost.

The Affordable Care Act (ACA) mandated that employers and insurers cover “evidence-based items or services that have in effect a rating of ‘A’ or ‘B’ in the current recommendations” of the USPSTF without cost-sharing requirements. But the plaintiffs said they wanted an insurance option excluding or limiting coverage of contraceptives, preexposure prophylaxis drugs, the HPV vaccine and screenings and behavioral counseling for drug use and STDs, since “neither they nor their families require such preventive care” and that compulsory coverage violates their religious beliefs.

Judge Reed O’Conner ruled in favor of the plaintiffs, building on a September 2022 decision that the ACA requirement mandating insurers to provide plans covering HIV prevention drugs at no cost is unconstitutional. O’Conner also previously ruled that enforcing the USPSTF’s recommendations was unlawful and a violation of the Appointment Clause in the constitution.

Now, he has blocked the ACA’s requirement that most insurers cover a range of preventive care, including cancer screenings. However, he upheld the contraceptive coverage mandate and coverage requirements for immunizations and preventive services recommended by the Advisory Committee on Immunization Practices (ACIP) and the Health Resources and Services Administration (HRSA).

Michael Barry, MD, chair of the USPSTF, provided a statement to Healio that said the task force “is deeply committed to improving the health of people nationwide by making evidence-based recommendations that help clinicians and patients decide together which preventive services are right for them” and that their mission “has not changed since we began doing this work nearly 40 years ago.”

“From helping people find cancers early to preventing kids from starting to smoke, we believe that clinicians and patients have a right to know what the evidence shows about how best to stay healthy,” Barry said. “In recent years, we have seen the impact of this work, especially on those most in need of health care. Millions of people across the country rely on these services every day to help them get and stay healthy.”

As care has become more accessible in the last decade, more people with low incomes could access the care they need, like cancer screenings, Barry said.

“Fundamentally, people across the country deserve the opportunity to receive these important preventive services that have been proven to help them live longer and healthier lives,” he said.

Other organizations, like the ACP and American Academy of Family Physicians (AAFP), have expressed their concern at the decision.

Ryan D. Mire, MD, MACP, president of the ACP, said in a statement that the organization is calling for the decision to be reversed “before our patients begin losing access to preventive services.”

“Instead of attacking the coverage that patients have, we should be looking for ways to bolster the ACA and increase access to care,” Mire said in the statement. “With the increased subsidies for premiums for ACA plans, we have seen record enrollment over the last year. We should be looking for other ways to work toward universal coverage, rather than stripping away care from patients.”

Tochi Iroku-Malize, MD, FAAFP, president of the AAFP, said in a statement that the AAFP “is alarmed and disappointed” by the ruling that jeopardizes affordable, equitable access to evidence-based preventive services for millions.

“Eliminating the ACA’s requirement to cover services recommended by the USPSTF with no cost-sharing could result in millions of patients losing free coverage of screenings for cancer, heart disease, sexually transmitted infections, obesity, and mental health conditions, along with tobacco-cessation counseling and other essential preventive services,” Iroku-Malize said in the statement. “For many patients, this loss will place preventive care out of reach financially.”

Iroku-Malize added that although the organization is relieved by the court’s upholding of the contraceptive coverage mandate and coverage requirements for immunizations and preventive services recommended by ACIP and HRSA, it “urgently calls on lawmakers, insurers and health plan sponsors to ensure that patients can continue to access high-value, essential preventive services without cost-sharing.”

References:

• Braidwood Management Inc. et al. v Xavier Becerra et al. https://storage.courtlistener.com/recap/gov.uscourts.txnd.330381/gov.uscourts.txnd.330381.113.0.pdf. Accessed March 30, 2023.
• Braidwood Management Inc. et al. v Xavier Becerra et al. https://storage.courtlistener.com/recap/gov.uscourts.txnd.330381/gov.uscourts.txnd.330381.92.0_4.pdf. Accessed Sept. 8, 2022.
• Family Physicians Alarmed Braidwood Management Inc. v. Becerra Ruling Threatens Preventive Care. https://www.aafp.org/news/media-center/releases/braidwood-management-inc-v-becerra-ruling.html. Published March 30, 2023. Accessed March 30, 2023.
• Internal Medicine Physicians Say Decision Against ACA Preventive Services Will Harm the Health of Americans. https://www.acponline.org/acp-newsroom/internal-medicine-physicians-say-decision-against-aca-preventive-services-will-harm-the-health-of. Published March 30, 2023. Accessed March 30, 2023.