HHS nears deal to preserve ACA preventive care mandate

The Biden administration has reached a tentative deal that would preserve a provision of the ACA requiring insurers to cover preventive services while a Texas judge's ruling against the mandate is appealed in court.

In a June 9 filing with the 5th U.S. Circuit Court of Appeals, attorneys for the involved parties said they hoped to submit a final agreement by June 13. 

Under the deal, the challenged ACA provision would remain in place while the case is appealed, but the Texas company that filed the lawsuit would be exempt. The company, Braidwood Management, would remain exempt if the appeals court restores the mandate.

In March, U.S. District Judge Reed O'Connor struck down the ACA provision requiring payers and employers to provide coverage for preventive services without copays. The judge's ruling said 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 ACA requires payers to cover more than 100 preventive health services recommended by the task force, which are used by about 100 million Americans annually, according to KFF.

The ruling applies only to task force recommendations made by the panel on or after March 23, 2010 (when the ACA became law), such as 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.

The Biden administration appealed the Texas ruling in early April. The 5th Circuit granted an administrative stay May 15 while the court reviews the case.

If Mr. O'Connor's ruling is not overturned by the 5th Circuit, payers would be able to charge members in new plans for preventive services.

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