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.
