A U.S. judge on March 30 struck down a provision in the Affordable Care Act that required insurers to cover some preventative services such as cancer screenings.
U.S. District Judge Reed O’Connor ruled that recommendations on preventative care by an unelected task force were unlawful, and forbade President Joe Biden’s administration from enforcing the recommendations.
The U.S. Preventive Services Task Force’s recommended preventative services must be covered by insurers under the Affordable Care Act (ACA), colloquially known as ObamaCare. It has recommended anxiety screening for some children and breast cancer screening for some women, among other recommendations.
Plaintiffs in a legal case in Texas argued that the mandated coverage violated their constitutional rights and the Religious Freedom Restoration Act because it forced them to purchase insurance that covered aspects that clash with their religion, including coverage of preexposure prophylaxis drugs for people deemed at high risk of getting HIV.
“The ACA forces these plaintiffs to choose between purchasing health insurance that violates their religious beliefs and foregoing conventional health insurance altogether. It is undisputed that putting individuals to this choice imposes a substantial burden on religious exercise,” O’Connor, a George W. Bush appointee, wrote in a 28-page opinion.
Under the religious freedom act, the government can substantially burden a person’s exercise of religion if it shows that the burden “is in furtherance of a compelling governmental interest” and “is the least restrictive means of furthering that compelling governmental interest.”
Government officials have failed on both fronts, the judge ruled.
While officials said there’s a compelling government interest in inhibiting the spread of diseases like HIV, the question is actually whether the government has a compelling interest in requiring insurers to cover the preexposure prophylaxis (PrEP) drugs, he said.
“But neither Congress nor [the task force] expressed that compelling interest and the ACA’s several exemptions for grandfathered plans and small businesses undermine Defendants’ argument that all insurers must provide plans with PrEP drug coverage,” the ruling stated. “Nor have Defendants offered any meaningful argument as to how the PrEP mandate satisfies the ‘exceptionally demanding’ least-restrictive-means test.”
The Department of Health and Human Services (HHS) and Department of Justice did not immediately respond to requests for comment.
O’Connor applied his ruling nationwide because the ACA provision and the task force’s recommendations are “constitutionally invalid,” the judge ruled. He ordered Biden administration officials not to enforce the compulsory coverage requirements for the task force’s recommendations.
O’Connor previously ruled that ObamaCare was unconstitutional, but the Supreme Court ultimately ruled in favor of the Biden administration, finding states lacked standing to challenge the law.
The ruling leaves intact mandated coverage of recommendations from the Health Resources and Services Administration and the Advisory Committee on Immunization Practices, which are both affiliated with HHS and subject to the supervision and direction of the department’s secretary. The task force is a volunteer body.
About 100 million people have received preventative care that is required to be covered since 2018, according to the Kaiser Family Foundation.
If the ruling stands after an expected appeal, many insurers will likely revert to charging copays for the affected preventative services, Lindsay Wiley, a law professor at the University of California, Los Angeles School of Law, predicted.
“In many cases, insurance contracts are in place for the calendar year, so people may not immediately have to pay for preventive services,” Larry Levitt, executive vice president for health policy for the foundation, said. “But over time, tens of millions of people could be affected by this court ruling.”