Court arguments began July 26 in the trial over an Affordable Care Act provision that requires payers to cover preventive services, including vaccinations, cancer screenings and HIV prevention drugs, according to The Commonwealth Fund, a nonprofit that supports independent research.
Ten things to know:
- The ACA currently requires commercial payers to cover preventive services with no cost sharing. The provision applies to individual, small group, large group and self-funded group plans.
- Preventive coverage includes cancer screenings, smoking-cessation services, vaccinations, contraception, maternal and postpartum services and youth developmental support.
- More than 150 million people received covered services under the provision in 2020.
- The lawsuit, Kelley v. Becerra, was filed in a Texas federal court by a coalition of employers and individuals that object to paying for certain health services.
- The plaintiffs argue the provision is unconstitutional in several ways. One argument claims the provision violates the Religious Freedom Restoration Act because it requires coverage of pre-exposure prophylaxis, a preventive HIV medication.
- The judge is likely to agree with the plaintiffs as he declined to dismiss their arguments earlier in the case, according to The Commonwealth Fund.
- If the plaintiffs win, payers would not have to cover preventive care for members, potentially leading to less access and worse health outcomes.
- The legal process could take years, with appeals of the Texas ruling expected in higher courts.
- Providers are largely opposed to ending the provision. The American Medical Association released a statement July 25 in conjunction with 61 medical associations to condemn the lawsuit. The provision is also supported by the Justice Department and 21 state attorneys general.
- If the provision is tossed, states and their marketplaces could still require payers to maintain preventive care coverage, but federal law prevents the same mandate for self-funded employer plans.