Federal judge awards partial victory to ACA opponents, rules against HIV drug coverage

A federal judge in Texas awarded a partial victory Sept. 7 to opponents of the ACA who challenged a key provision that requires payers and employers to cover preventive services.

U.S. District Judge Reed O'Connor declared a rule requiring health plans to cover preexposure prophylaxis, or PrEP, for HIV prevention unconstitutional, writing that the provision violates the religious freedoms of Braidwood Management, the Texas company that filed the original lawsuit in February 2021.

The ACA provision also requires coverage of vaccinations, cancer screenings, smoking-cessation services, contraception, maternal and postpartum services, and youth developmental support — preventive services that more than 150 million people received in 2020 alone.

Mr. O'Connor ruled that the provision as a whole is unconstitutional, but he did not strike it down nor issue an injunction. In addition, he upheld preventive services for women and children — autism and vision screenings, wellness visits, mammograms, and breastfeeding support programs. He also upheld the coverage requirement for immunizations.

According to CNN, it is currently unclear whether the decision only applies to Braidwood Management or nationwide. The judge has requested both parties file additional briefs related to the scope of relief and the ACA's contraception coverage requirement by Sept. 9.

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

The overall legal process for the preventive care provision 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. 

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