A The Texas federal judge, who previously ruled to overturn the Affordable Care Act, on Thursday struck down a narrower but important part of the nation’s health care law that requires most insurers to cover preventive services, including screening for cancer, diabetes and mental health.
Other free services, including HIV screening, are also affected by US District Judge Reed O’Connor’s decision, which opponents say will jeopardize screening for millions of Americans.
Experts warned that insurers are unlikely to stop providing coverage immediately. The Biden administration was expected to appeal and request a stay of the sentence.
“This isn’t the potential death knell for the ACA like previous lawsuits, but it would curtail a very popular benefit enjoyed by tens of millions of people,” said Larry Levitt, executive vice president of health policy at the Kaiser Family Foundation.
The decision comes more than four years after O’Connor, a candidate for former President George W. Bush, ruled that the entire health care law, also known as “Obamacare,” was unconstitutional. The US Supreme Court overturned this ruling.
This time, O’Conner just blocked a requirement that most insurers cover a range of preventive measures – including screening for multiple cancers – and sided with plaintiffs, including a conservative Texas activist and a Christian dentist who oppose the mandatory coverage of contraceptives and HIV pronounce prevention treatment on religious grounds.
Coverage requirements are determined by recommendations from the US Preventive Services Task Force, which is made up of volunteers. O’Connor ruled that enforcing the recommendations was “unlawful” and a violation of the Constitution’s appointment clause, which governs how government officials may be appointed.
dr Michael Barry, chair of the federal task force, said in a statement after the ruling that people on low incomes have been able to get the services they need as care has been expanded over the past decade under the law.
“Basically, people across the country deserve the opportunity to access these important prevention services that have been shown to help them live longer, healthier lives,” Barry said.
White House press secretary Karine Jean-Pierre said the Justice Department and Department of Health and Human Services are reviewing the ruling but called the case “another assault” on the health law, which has been in effect for 13 years and has survived multiple legal challenges.
The Biden administration previously told the court that the outcome of the case “could result in extraordinary upheaval in the United States public health system.” More than 20 states, mostly controlled by Democrats, had pushed O’Connor against a sweeping ruling that would remove the requirement for preventive care coverage entirely.
The ruling applies to recommendations made by the task force following the enactment of the Affordable Care Act in March 2010. Some of the country’s largest medical groups contested the lawsuit, warning that insurers could in future charge patients for screenings that were carried out are now fully covered.
Levitt said if O’Connor’s decision stands, insurers will likely be evaluating changes in coverage starting next calendar year, as existing contracts are already in effect.
Although the ruling affects a broad spectrum of screening, it does not erase coverage of all screenings. For example, experts said the decision would not remove coverage for preventive health services for women approved outside of the task force.
Some cancer screenings approved before 2010 are also unaffected, including screenings for cervical and colorectal cancer, said Alina Salganicoff, senior vice president and director of women’s health policy at the Kaiser Foundation. However, she said screenings for lung and skin cancer, which were recently approved, could be affected.
In September, O’Connor ruled that requiring coverage for the HIV prevention treatment known as PrEP, a pill taken daily to prevent infection, violated the plaintiffs’ religious beliefs. That decision also undermined the broader system that determines what preventive medications are covered in the US, ruling that a federal working group recommending coverage for preventive treatments is unconstitutional.
Employers’ religious objections have been a sticking point in previous challenges to former President Barack Obama’s health care law, including contraception.
The lawsuit is among attempts by Conservatives to sidestep the Affordable Care Act — or wipe it out entirely — since it came into force in 2010. The attorney who filed the lawsuit was an architect of Texas’ abortion law, which was the nation’s strictest before the Supreme Court ruled Roe v. Wade in June, allowing states to ban the procedure.
Associated Press reporters Amanda Seitz and Seung Min Kim in Washington contributed to this report.
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