Texas judge tosses range of preventive care coverage under ACA

A federal judge in Texas has struck down an ACA provision that requires insurance companies to provide coverage for preventive services such as certain cancer screenings and HIV prevention drugs.

U.S. District Judge Reed O’Connor said in his March 30 ruling 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. 

About 100 million Americans use free preventive services annually, which insurers had to cover without cost-sharing. The ACA requires payers to cover more than 100 preventive health services recommended by the task force.

The new ruling only applies 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. STI 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 the Kaiser Family Foundation, told reporters March 30. "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's 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 upwards of $20,000 annually.

"As we review the decision and its potential impact with regard to the preventive services recommended by the United States Preventive Services Task Force, we want to be clear: Americans should have peace of mind there will be no immediate disruption in care or coverage," AHIP President and CEO Matt Eyles said March 30.

The Justice Department is likely to appeal the decision and can ask that the judge's ruling be paused while the appeal is pending.

Judge O’Connor previously ruled the entire ACA unconstitutional in 2018, though that decision was struck down by the U.S. Supreme Court.


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