Court Partially Rejects Mandate to Cover Preventive Care

​On Sept. 7, a federal judge partially struck down the Affordable Care Act's (ACA's) requirement that insurers cover certain types of preventive care.

The ACA requires group health plans to cover more than 100 preventive health services with no cost to patients. These include routine vaccines, well-child visits, and screenings for cancer, depression, hepatitis B and C, hypertension, and osteoporosis.

Judge Reed O'Connor of the United States District Court for the Northern District of Texas concluded that the Preventive Services Task Force (PSTF), an expert panel that releases binding recommendations for what preventive care must be covered under the law, violated the U.S. Constitution because its members are not appointed by the president or confirmed by the U.S. Senate.

"Birth control will still be covered because it's recommended by another agency, the Health Resources and Services Administration (HRSA), which the court kept intact," said Andrew Twinamatsiko, associate director of the Health Policy and the Law Initiative at the O'Neill Institute at Georgetown Law School in Washington, D.C. "The court ruled that HRSA recommendations were constitutionally valid because, unlike the PSTF, HRSA is answerable to the U.S. Health and Human Services secretary. The same goes for vaccines that are recommended by the Advisory Committee on Immunization Practices (ACIP). Those immunizations stay, as well, for the same reason HRSA recommendations stay."

"Employers should be aware that [the judge] has not yet determined the practical implications of his ruling and who it will apply to, and it's likely to be appealed," said Jeff Levin-Scherz, population health leader for WTW in Belmont, Mass. "We expect most employers will continue to cover screening tests for cancer without cost-sharing because they recognize that these services improve health, and some of them lower future costs. This coverage is also popular with employees, especially those who are in good health and choose insurance with high deductibles."

We rounded up a group of articles on the news from SHRM Online and other trusted news sources.

Religious Objection

The judge ruled that the federal government cannot require a Christian-owned company to cover HIV-prevention drugs for its employees because that would violate the owners' religious freedom. Steve Hotze, one of the plaintiffs and owner of the Christian corporation Braidwood Management, objected to providing coverage for HIV-prevention drugs, saying they "facilitate and encourage homosexual behavior and sexual activity outside of marriage between one man and one woman."

This week's court ruling followed up on the 2014 Hobby Lobby case, in which the U.S. Supreme Court ruled that the federal government cannot require a company to provide coverage for contraception if the owner has a religious objection to it.

(The Washington Post)

Outlook Unclear

It remains unclear whether the ruling will apply only to Braidwood Management or affect Americans nationwide. The court did not issue a nationwide injunction or vacate the rule. The judge has requested that both sides file additional briefs relating to the scope of relief by Sept. 9. The ACA provisions remain in effect for now. The judge upheld the mandate for certain preventive services, such as mammograms, breastfeeding support, and autism and vision screenings for children.

(CNN)

Medical Groups Voice Opposition

If it's permitted to apply nationwide, the latest court ruling could jeopardize millions of Americans' access to preventive services. It does not take effect immediately, however, and legal experts said the Biden administration will almost certainly appeal.

The American Medical Association (AMA) was among many health-focused groups that denounced the ruling. "Stripping this key coverage mandate is inequitable, harmful and will make people sicker," said Dr. Jack Resneck Jr., the AMA's president.

(The New York Times)

Federal Guidance

Earlier this year, the federal government released guidance in a set of frequently asked questions, which addressed required coverage for contraception and follow-up colonoscopies for Americans ages 45 to 49 under the ACA. Health plans must cover without cost-sharing all contraceptive products approved by the U.S. Food and Drug Administration that are deemed medically appropriate by a patient's health care provider.

(SHRM Online)

Coverage for HIV Prevention

Last year, the federal government published frequently asked questions that confirmed health plans must cover HIV-prevention medication and essential support services such as HIV testing, Hepatitis B and C testing, and sexually transmitted infection screening. Preexposure prophylaxis, commonly known as PrEP, reduces the risk of contracting HIV from sex by roughly 99 percent and from drug injection by about 74 percent. The federal judge concluded that the burden was on the government to show that the PrEP coverage mandate furthers a compelling governmental interest and is the least restrictive means of furthering that interest.

(SHRM Online and Roll Call)