A federal appellate court will hear arguments March 4 on the Biden administration's appeal of a judge's ruling that struck down an ACA provision that requires insurance companies to provide coverage for preventive services such as certain cancer screenings and HIV prevention drugs.
In March 2023, U.S. District Judge Reed O'Connor ruled that preventive care recommendations made by the U.S. Preventive Services Task Force do not need to be complied with and blocked the federal government from enforcing its recommendations.
The Biden administration appealed the case in April. An HHS spokesperson said, "Actions that strip away this decade-old protection are backwards and wrong."
The ruling applies to task force recommendations made by the panel on or after March 23, 2010 — when the ACA became law — with respect to statins, lung and skin cancer screenings, and pre-exposure prophylaxis, or PrEP, an HIV prevention drug. Sexually transmitted infection screenings and cancer screenings such as mammograms and cervical screenings would still be included for preventive coverage.
"As sweeping as this ruling is, it does not immediately overturn preventive services," Larry Levitt, executive vice president for health policy at KFF, told reporters in March 2023. "Previous cases to the ACA have threatened the very existence of the law. This case does not do that. It strikes a certain portion of the law, albeit a very popular one."
It is likely that most insurers will still cover preventive services, but they may raise cost-sharing for members for certain services, according to KFF. An increase in costs will not happen immediately because of current contracts, but that could change in the next calendar year. For PrEP specifically, there could be substantial cost-sharing. Generic PrEP costs around $360 a year, while branded prescriptions can reach upward of $20,000 annually.
In June, the U.S. 5th Circuit Court of Appeals temporarily blocked the ruling.
Mr. O'Connor previously ruled the entire ACA unconstitutional in 2018, though that decision was struck down by the U.S. Supreme Court. Laurie Sobel, associate director for women's health policy at KFF, told The Hill on March 3 that this case is likely to head to the Supreme Court as well.