Braidwood Decision Ends Free Lifesaving Preventive Health Care for 150 Million Americans
Yesterday, U.S. District Judge Reed O’Connor struck down a major provision of the Affordable Care Act (ACA) that requires no-cost coverage of lifesaving preventive health care services.
Braidwood Management v. Becerra is the latest effort by ACA opponents and Republicans to use the courts to dismantle American health care. Judge O’Connor invalidated all of the benefits covered under the U.S. Preventive Services Task Force, including lifesaving colorectal and other cancer screenings, anxiety and depression screenings for children and adults, heart disease screenings, and access to PrEP (pre-exposure prophylaxis), which can substantially reduce the chance of contracting HIV. The ruling applies nationwide.
Patient groups, health care experts, and advocates sounded the alarm that yesterday’s decision to end the ACA’s guaranteed free access to essential preventive services will harm patients and dismantle “bedrock protections” in our health care system.
American Medical Association Said This “Court Ruling Jeopardizes Access To Vital Preventive Health Services.” “The AMA is alarmed by today’s deeply flawed court ruling in Texas that jeopardizes access to preventive health services guaranteed under federal health reform, including drugs preventing HIV transmission. A critical section of the Affordable Care Act (ACA) required insurers and health plans to cover dozens of preventive health services with no cost to patients—eliminating copays and deductibles for the early detection of potentially fatal medical conditions, including cancer, hypertension, diabetes, and sexually-transmitted infections. Millions of patients could lose first-dollar coverage for cholesterol treatment, tobacco and alcohol cessation, immunizations, and childhood screenings for lead poisoning, hearing loss, and autism. Care that is critical to reducing maternal mortality would also be jeopardized. These preventive-care requirements that for ten years have enabled millions of Americans to improve their health could just go away as a result of this flawed ruling. Providing insurance coverage for screenings and interventions that prevent disease saves lives—period. Invalidating this provision jeopardizes tools physicians use every day to improve the health of our patients. And the burden of losing this first-dollar coverage will fall disproportionately on low-income and historically marginalized communities that are least able to afford it and are often at high risk of developing preventable medical conditions.” [AMA, 3/30/23]
The American Lung Association and 25 Other Patient Groups Released a Joint Statement Highlighting “This Ruling Directly Threatens These Benefits And Would Result In A Return To Financial And Other Barriers Proven To Discourage Americans From Obtaining Lifesaving, Preventive Care.” “Individuals will not immediately lose access to these preventive services because the Court has not yet ruled on the scope of relief or remedy. However, this decision could ultimately allow the reinstatement of financial barriers that in the past discouraged all too many Americans from obtaining preventive care, such as screenings for cancer and hypertension, helping people who smoke quit, and preventive care for pregnant women and babies. Among the Affordable Care Act’s most popular and effective provisions have been the requirement that insurance cover â€“ without cost-sharing â€“ services that help screen for and prevent disease. Access to preventive healthcare can prevent both disease and early death. In recent years, more than 150 million Americans have benefited from expanded access to preventive services under the Affordable Care Act. Studies repeatedly show that high-quality coverage, complete with preventive services, improves the overall health of individuals and our country, lowers overall health spending, and reduces health disparities. This ruling directly threatens these benefits and would result in a return to financial and other barriers proven to discourage Americans from obtaining lifesaving, preventive care. Our organizations are deeply committed to ensuring everyone has access to the care they need, and we will vigorously defend individuals’ rights to access these critical services.” [American Lung Association, 3/30/23]
- Signatory groups: The AIDS Institute, American Cancer Society Cancer Action Network, American Heart Association, American Kidney Fund, American Lung Association, Arthritis Foundation, Cancer Support Community, Cystic Fibrosis Foundation, Epilepsy Foundation, Hemophilia Federation of America, JDRF , The Leukemia & Lymphoma Society, Lupus Foundation of America, The Mended Hearts, Inc., Muscular Dystrophy Association, National Alliance on Mental Illness (NAMI) , National Coalition for Cancer Survivorship, National Health Council, National Hemophilia Foundation, National Kidney Foundation, National Multiple Sclerosis Society, National Organization for Rare Disorders, National Patient Advocate Foundation, National Psoriasis Foundation, Susan G. Komen, WomenHeart: The National Coalition for Women with Heart Disease
American College of Obstetricians and Gynecologists Said “Allowing Personal Or Political Bias To Interfere With The Practice Of Medicine Will Cause Harm To Our Patients.” “No-copay coverage of critical preventive care like HIV prevention is intended to increase access in order to keep people healthier. Preventive care improves health and saves lives, and it also reduces overall costs to the health care system. An individual’s personal belief does not change the fact that HIV prevention helps people live healthy lives. To improve health outcomes, we should be working toward increased access to and utilization of all preventive care recommended by the U.S. Preventive Services Task Force. Instead, we find ourselves once again defending health care from outside interference and responding to attempts to dismantle our current preventive care system. Today’s decision will leave more people without access to preventive care and will grow health inequities among those who will now find themselves underinsured.” [ACOG, 3/30/23]
Dr. Georges C. Benjamin, Executive Director of the American Public Health Association Said “The Impact Of This Decision Is Disastrous For The Public.” “As a physician, the impact of this decision is disastrous for the public. The Affordable Care Act was designed to move our health system to address prevention and it has been highly successful in doing that. Preventative services are highly effective, and we know that from a medical perspective, this will undermine our ability to protect people and save lives.” [Protect Our Care Event, 3/30/23]
Margaret A. Murray, CEO of the Association for Community Affiliated Plans, Said “Families Deserve Better Than Having Bedrock Protections Of The Health Reform Law Invalidated With A Two-Page Ruling.” “We call on the Justice Department to appeal this ruling such that this decision can be stayed to give the necessary acts of jurisprudential hygiene time to occur. In the interim, our Safety Net Health Plans will continue to work to equitably improve the health of all their members – regardless of their sexual orientation or their gender identity.” [ACAP, 3/30/23]
The Philadelphia Health Department’s Dr. Kathleen Brady Makes Statement Regarding How This Ruling Will Hurt Local Government Initiatives. “With an ambitious goal of reducing HIV infections by 90% by 2030, Philadelphians need access to PrEP without barriers, financial or otherwise. This ruling hurts the members of our communities who routinely face discrimination and are at increased risk of HIV exposure, particularly Black, Latino, and LGBTQ+ Philadelphians. This decision has been heavily criticized by medical professionals throughout the nation and we add our voice to that chorus. The Health Department is here to ensure that everyone who needs HIV prevention services can get them.” [Philadelphia Health Department, 3/30/23]
Cofounder of United States of Care, Natalie Davis, Said “The Resulting Impacts Of This Decision Will Be Widespread, Starting With The Fact That It Creates Uncertainty For People Seeking Care.” “Free preventive screenings are one of the most popular parts of the health care system across demographics and party lines, with nearly two-thirds of people expressing support for these policies. To put it bluntly, no-cost preventive services save lives. Since these protections went into effect, cancer deaths have dropped by 17%, while new HIV infections have decreased by 73% since the mid-1980’s. Changes to preventive services benefits will have a disproportionate impact on communities of color and communities who are always pushed to the margins of our health care system, exacerbating existing health disparities and erecting additional barriers to services. People need more access to no-cost preventive services, not less.The progress we have made with prevention through access to no cost screenings – in narrowing health disparities, and increasing access to needed – care is now in jeopardy – people’s lives are at stake. We can’t go backwards.” [United States of Care, 3/30/23]
The National Coalition of STD Directors: A Joint Statement from the Group Wholly Condemns the Ruling by Judge Reed O’Connor. “Today’s ruling threatens the most powerful tools this nation has to fight the epidemic of sexually transmitted infections (STIs) – guaranteed insurance coverage for basic preventive medical care. We cannot reduce the devastating impact of completely preventable infections like congenital syphilis if people cannot count on their insurance to help them pay for essential routine health services. As our public health systems have buckled under the strain of rising disease rates and falling funding, we have grown increasingly reliant on the routine, privately funded health services that most people use to access services like standard syphilis testing during routine prenatal care or HIV tests in our yearly check-ups. This ruling rips out the backbone of the U.S. health care system, and risks the future health of every single American. STIs impact people of all walks of life and can have devastating consequences when left undetected and untreated. The overreach of one judge should not threaten the health and safety of hundreds of millions of lives. We are calling on the Biden administration to use its full weight to safeguard preventive services coverage for all Americans.” [National Coalition of STD Directors, 3/30/23]
National Partnership For Women And Families: “This Ruling From Judge O’Connor Is Devastating.” “This ruling from Judge O’Connor is devastating. Striking down coverage for preventative care hurts all of us but especially folks of color and low-income people who have overwhelmingly benefited from this provision.” [@NPWF, 3/30/23]
Professor of Pediatrics at Yale, Meredithe McNamara: Ruling in Braidwood Case is More “Sinister” Than Even Burwell v. Hobby Lobby Stores, Inc. “Per Braidwood, anyone with an objection to LGBTQ identity can claim that providing healthcare for LGBTQ people harms their religious beliefs. In a time when the rights of transgender people are debated in state legislatures throughout the U.S., Braidwood is a clear example of a judicial attack meant to embolden those with prejudice to further harm LGBTQ people.” [Yale Daily News, 3/31/23]
Dr. A. Mark Fendrick of the University of Michigan, One of the Original Drafters of the Preventive Care Mandate, Blasts the Braidwood Ruling. “Requiring patients to pay significant amounts out-of-pocket for high-quality preventive services shouldn’t be a partisan issue. Whether you’re a Democrat or a Republican, it’s just good policy to promote access to services that have been proven to prevent diseases or to detect conditions while they’re still treatable.” [University of Michigan, 3/30/23]
Attorney General Rob Bonta Released a Statement on the Braidwood Ruling. “Preventive healthcare is crucial to saving lives and keeping people healthy and safe. From cancer screenings to pregnancy-related care, to HIV medication, preventive care is a critical aspect of healthcare. I am deeply disappointed in today’s dangerous and short-sighted court ruling in Texas. It puts ordinary Americans’ lives at risk and deprives them of access to the medical care and services they need. We will not let this stand.” [State of California Department of Justice, 3/30/23]
Ben Klein, GLBTQ Legal Advocates & Defenders (GLAD) Senior Director Said “Today’s Order In Braidwood V. Becerra Will Have Direct And Devastating Consequences For Efforts To Combat The HIV Epidemic.” “We have a safe, approved therapy PrEP (Preexposure Prophylaxis), that is nearly 100% effective at preventing transmission of HIV but that remains underutilized, particularly among Black and Latinx communities. Ending the requirement that insurers cover PrEP with no cost-sharing will increase new HIV diagnoses and exacerbate racial health disparities when what we need is to be ensuring more people have access to PrEP. Copays and deductibles deter people from accessing healthcare. Make no mistake, we will see more HIV transmission as a result of this ruling.” [GLAD Legal Advocates and Defenders, 3/30/23]