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Judge Strikes Down Key ACA Provision Guaranteeing Free Preventive Care Relied on By Millions of Americans

By September 8, 2022No Comments

Ruling Also Explicitly Puts Guaranteed Free Contraception at Risk

Washington DC — Yesterday, U.S. District Judge Reed O’Connor struck down a key Affordable Care Act (ACA) provision guaranteeing free preventive care relied on by millions of Americans. This ruling takes away all of the benefits covered under the U.S. Preventive Services Task Force, including lifesaving colorectal and other cancer screenings, depression screenings, hypertension screenings, and access to PrEP (pre-exposure prophylaxis). The ruling also specifically put free contraception relied on by nearly 70 million people at risk and left open the door to wipe out free access to prenatal care, vaccinations, and more. More than 150 million Americans relied on these services in 2020. Read more about the case here. 

“Health care services relied on by more than 150 million Americans are now at risk. The free preventive care guaranteed by the ACA has become a bedrock of our health care system, benefiting patients with all types of insurance, including those insured by their employer. The consequences of this ruling cannot be understated and it is essential that Judge O’Connor stay the effects of his order while this disastrous decision is appealed,” said Protect Our Care Chair Leslie Dach. “This case is politically-driven, brought by longtime adversaries of the ACA, women’s health, and LGBTQ rights. Let’s be clear: access to free preventive care protects us from serious diseases, reduces racial disparities, and saves lives. And this decision comes at a time when Republicans in Congress have vowed to repeal the ACA, sunset Social Security and Medicare, and repeal the Inflation Reduction Act’s provisions to lower drug prices.” 


Axios: Republican Judge’s Ruling Give Democrats More Reason to Run on Healthcare. “For the second election cycle in a row, a Republican-appointed federal judge in Texas has given Democrats an opening to campaign on saving the Affordable Care Act. Democrats have been trying to make the case that Republicans support undoing popular health care policies — like their recently-passed prescription drug law that allows Medicare to negotiate directly with manufacturers — in addition to highlighting the party’s support for abortion bans. ‘Don’t get it twisted: the GOP does have a health care agenda, and it includes cutting Social Security and Medicare and banning abortion with no exceptions for rape or incest,’ the DNC wrote in an email earlier this week.” [Axios, 9/8/22]

Axios: Sweeping Implications for Preventive Care as Court Ruling Put Major Portion of the ACA at Risk. “A federal court ruling that struck down required coverage of HIV prevention medication may have far more sweeping implications for whether insurers will have to continue offering a range of no-cost preventive health services. ‘This is not just about PrEP. It’s much broader,’ Katie Keith, a health law expert at Georgetown University told Axios. ‘If we lose the A or B recommendations, then any employer or plan, religious objection or not, could say we’re not going to cover that anymore.’ Jonathan Adler, a Case Western Reserve University law professor, agrees. The ruling suggests ‘self-insuring employers could pick and choose what they want to cover based on religious objections to certain types of coverage.’” [Axios, 9/8/22]

Managed Healthcare Executive: Insurers Will be Forced to Increase Costs for Consumers Due to Ruling. “…the president of the nonprofit Chorus Community Health Plans in Milwaukee says that a federal lawsuit filed by conservative groups in Texas to eliminate that ACA preventive services requirement for more than 100 services may force him to do something he doesn’t want to do – make enrollees pay deductibles or copayments for these services. Zachary Sherman, executive director of Pennie, the ACA marketplace in Pennsylvania, unhappily agrees. ‘We’d push insurers to continue offering no-cost preventive services, but I can see some plans wanting to put up cost sharing to make sure their premiums are more competitive,’ he says. ‘That would erode the progress we’ve made in making sure people have ready access to immunizations and other key preventive services.’” [Managed Healthcare Executive, 9/7/22]

NBC News: Federal Judge Rules Against Free Coverage of HIV Drugs. “A federal judge in Texas has ruled that a provision of the Affordable Care Act that mandates free coverage of certain drugs that prevent HIV infections violates the religious beliefs of a Christian-owned company. ‘This ruling is shocking on every level,’ said Mitchell Warren, executive director of the HIV nonprofit AVAC. ‘It defies evidence, logic, public health and human rights and sets back enormous progress in the fight to end the HIV epidemic.’ PrEP is a ‘core component’ in the fight against the spread of HIV, he said.” [NBC News, 9/7/22]

US News: Judge Undercuts System Used to Determines Which Preventative Drugs Are Covered. “The ruling was handed down by Fort Worth-based U.S. District Judge Reed O’Connor, who ruled in 2018 that the entire ACA is invalid. The U.S. Supreme Court ultimately overturned that decision. The impact of the ruling beyond the plaintiffs was not immediately clear. But opponents condemned the decision as a threat to patients far beyond Texas. The Biden administration is likely to appeal.” [US News, 9/7/22]

Washington Post: ACA No Long Can Mandate Businesses Cover Costs of Certain Preventive Drugs. “The ruling is the latest in a series of challenges to the health-care law. O’Connor himself ruled the entire law unconstitutional in late 2018 — a decision that did not stand after the Supreme Court upheld the law 7-2 last year, the third time the body had considered such a challenge. Consumer organization Protect Our Care said the ruling ‘threatens the Affordable Care Act preventive services requirement that guarantees free access to over 100 preventive health services, including health screenings, routine vaccinations, well baby and child visits, prenatal care, contraception, and more,’ services used by 150 million Americans, according to the group.” [Washington Post, 9/7/22]


House Speaker Nancy Pelosi Makes Statement on the “Extreme MAGA Judge” Who Ruled Against the ACA. “Today, a radical, Republican-appointed federal judge ruled that employers can deny coverage for PrEP: a drug proven to save lives from HIV/AIDS and a key strategy for ending the epidemic.  This disturbing decision amounts to open homophobia: unleashing unthinkable suffering and death specifically among the LGBTQ community.  This decision also threatens vital preventative health services guaranteed under the Affordable Care Act, including birth control, vaccinations and routine health screenings. This extreme MAGA ruling comes just months after the Republican-controlled Supreme Court discarded precedent and privacy in overturning Roe v. Wade.  Since then, House Republicans have plotted an unhinged, dangerous campaign to punish our most personal decisions, from abortion care to birth control and more.” [9/7/22]

President of the Cancer Action Network, Lisa Lacasse, Makes Dire Warning About the Ruling. “”Before the passage of the Affordable Care Act, high costs and unclear coverage were repeatedly cited among the top reasons people delayed or skipped screenings. We cannot risk returning to a system wherein every individual has to interpret their complex insurance plans to determine if a recommended mammogram will be covered or to determine how much their colonoscopy may cost. We strongly urge the government to swiftly appeal this ruling. Cancer patients, survivors and all those at risk for the disease cannot face undue barriers around cost and coverage of these services” [9/7/22]

Dean of Rutgers School of Public Health, Perry Halkitis, Condemns Texas Judge’s Ruling. “The ruling by U.S. District Judge Reed O’Connor is extremely shortsighted. It is reminiscent of decisions in the 1990s to prevent the distribution of condoms in schools. Without covering PrEP, highly at-risk populations — mostly gay and bisexual men and Black women — will continue to become infected with HIV, perpetuating this ongoing epidemic in our society. The decision of the judge is ultimately one that will spread further disease and cause harm to the people of Texas. In the end, this will lead to an increase in the number of infections in people living with HIV in Texas and across the United States, creating a larger number of individuals who require lifelong treatment and creating burdens on their lives and creating burdens on our economy.” [9/7/22]

Executive Director of HIV+Hepatitis Policy Institute, Carl Schmid, Makes a Statement to News Outlets. ““Preventive services covered by private insurance plans without cost-sharing, such as HIV testing, hepatitis B and C testing, and PrEP, are all critical and well-established public health preventive services that must continue. To single out PrEP, which are FDA approved drugs that effectively prevent HIV, and conclude that its coverage violates the religious freedom of certain individuals, is plain wrong.” [9/7/22]