Appeals court pauses Texas ruling against ACA preventive care coverage

The U.S. 5th Circuit Court of Appeals has temporarily blocked a Texas court's ruling earlier this year that struck down an ACA provision requiring payers and employers to provide coverage for preventive services.

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 have to cover without cost-sharing. The ACA requires payers to cover more than 100 preventive health services recommended by the task force.

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.

It is likely that most insurers will continue to cover preventive services, though they may raise cost-sharing for members for certain services in the future, 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.

Mr. O'Connor previously ruled the entire ACA unconstitutional in 2018, though that decision was struck down by the Supreme Court. The decision to strike down covered preventive services was spurred by a lawsuit brought forth in 2021 by Braidwood Management, a Texas company arguing the ACA provision violates its religious freedoms.

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