‘Mixed Bag’ for Preventive Care in Appeals Court Ruling

Health plans must continue to cover preventive care at no cost under the Affordable Care Act (ACA), a federal appeals court ruled June 21, a ruling that has significant implications for employers. But the ruling may also open the door to more challenges because it allows the plaintiffs not to comply.

The 5th U.S. Circuit Court of Appeals reversed aspects of a ruling that would have blocked nationwide requirements under the ACA that certain preventive services be covered by insurers at no cost—those issued by the U.S. Preventive Services Task Force—but they did so with a caveat: The court ruled that the employers that challenged the provision do not have to comply.

In 2020, two Christian-owned companies in Texas, Braidwood Management and Kelley Orthodontics, sued the federal government over the ACA’s requirement that their health plans cover contraception, HPV vaccines, and medicines to prevent HIV for free, arguing that the services violate their religious beliefs. That case went to a federal judge, and last year, U.S. District Judge Reed O’Connor struck down the recommendations issued by the U.S. Preventive Services Task Force that were not already in place at the time the Affordable Care Act was signed into law in 2010, agreeing with the challengers’ argument that the task force violated the U.S. Constitution’s appointments clause.

“Our decision today is something of a mixed bag,” the court said in its final opinion.

We’ve gathered articles on the news from various outlets.

A Call to Revisit Requirements

The 5th Circuit also called on the lower court to revisit whether the federal government has properly approved requirements that insurers cover other preventive care services outside of the scope of the U.S. Preventive Services Taskforce, such as vaccines and contraception.

(Axios)

Background on the Ruling

Last year, O’Connor struck down the recommendations issued by the U.S. Preventive Services Task Force that were not already in place at the time the ACA was signed into law in 2010, agreeing with the challengers’ argument that the task force violated the Constitution’s appointments clause.

Had O’Connor’s ruling gone into effect nationwide, it would have invalidated the no-cost coverage mandates for some cancer screenings, the use of statins to prevent cardiovascular disease, and counseling referrals for pregnant and postpartum women at increased risk of depression, as well as for the HIV-prevention medication commonly known as PrEP. O’Connor also stuck down the PrEP mandate on the claim that it violated the Religious Freedom Restoration Act.

(CNN)

What It Means for Employers

Not all preventive care is threatened by the ruling. Attorneys on both sides said that some employers could decide to adopt copays or deductibles that would keep the affected coverages—including HIV prevention medication—available, even if they weren't offered for free.

An analysis prepared last year by nonprofit KFF found that some screenings, including mammography and cervical cancer screening, would still be covered without out-of-pocket costs because the task force recommended them before the health care law was enacted in March 2010.

(AP)