On Thursday, a federal judge in Texas blocked a key part of the Affordable Care Act (ACA), also known as Obamacare, which mandated that health insurance plans must cover preventive care, including screenings for certain cancers and pre-exposure prophylaxis against HIV (PrEP), without any cost to patients. The decision by U.S. District Judge Reed O’Connor in Fort Worth, Texas, is a victory for conservative groups and individuals who have challenged these mandates since 2020, and who claimed that it violates federal religious freedom laws. The judge previously found that the PrEP mandate was unconstitutional and that other no-cost preventive care mandates were based on recommendations by an illegally appointed task force.
The ruling will have a significant impact on more than 150 million people who were eligible for preventive care free of charge under the ACA as of 2020. If the decision is not overturned on appeal, insurance companies will be able to charge patients copays and deductibles for preventive care services in new insurance plans. While the ruling does not apply to preventive services that were recommended before the ACA was enacted, the American Cancer Society Cancer Action Network warned that the ruling could have “huge implications” and make it more difficult to catch treatable cancers early.
Several major medical groups have criticized the decision, including the American Medical Association and the American College of Obstetricians and Gynecologists. They argue that the ruling is “deeply flawed” and that patients will be subjected to needless illness and preventable deaths as a result. However, the health insurance industry’s largest trade group, AHIP, said there would be no immediate coverage interruptions, and that every American deserves access to high-quality affordable coverage and healthcare, including affordable access to preventive care and services that help avoid illnesses and other health problems.
The legal challenge was brought by eight individuals and two businesses from Texas who argued that the free PrEP requirement encouraged “homosexual behavior, prostitution, sexual promiscuity, and intravenous drug use” despite their religious beliefs. They also argued that the advisory body that recommends what preventive care should be covered without cost, the Preventive Services Task Force, is illegal because its members are not directly appointed by the president, which they claim is required by the U.S. Constitution. The task force’s recommendations automatically become mandatory under the Affordable Care Act.
The ruling may also impact access to PrEP, a drug used to prevent HIV infection, which can cause AIDS, made by Gilead Sciences Inc and by ViiV Healthcare, a joint venture of GSK Plc, Pfizer Inc, and Shionogi & Co Ltd. GSK and ViiV said they were “concerned about any court order or policy that could negatively impact access to important health prevention services, including PrEP for HIV” and supported an appeal of O’Connor’s order. The ruling is expected to be appealed.
