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Appeals Court Pauses Ruling That Threatened Free Preventive Health Care

The New York Times
May 15, 2023
By Emily Baumgaertner

A federal appeals court on Monday temporarily blocked a lower court decision that overturned the Affordable Care Act’s requirement that all health plans fully cover certain preventive health services.

The move by the U.S. Court of Appeals for the Fifth Circuit in New Orleans will put on hold a decision from March that had threatened insurance coverage for recommended services like depression screenings for teenagers and drugs that prevent transmission of H.I.V. The Justice Department had appealed the decision, and the appeals court’s stay will stand while the appeals process plays out.

A person's hands holding a bottle of pills.
A bottle of Truvada PrEP HIV prevention medication is inspected at a pharmacy in New York.Credit…Nicole Bengiveno/The New York Times

The ruling earlier this spring overturned one of the most popular requirements of the Affordable Care Act by taking away the financial barriers to a range of preventive services. It had taken effect immediately nationwide and had the potential to affect roughly 150 million Americans enrolled in private health insurance, either through employer-sponsored plans or through the Obamacare marketplaces.

While the case is under review, full coverage for preventive services will be legally required.

Earlier this year, Judge Reed O’Connor of the Federal District Court for the Northern District of Texas ruled that insurers did not have to cover any of the services that had been recommended by the United States Preventive Services Task Force since 2010. His reasoning: The task force is not appointed by Congress and therefore did not have the constitutional authority to decide what services a health insurer must cover.

That ruling had built upon previous ones: In 2018, Judge O’Connor had ruled that the A.C.A. was unconstitutional (though the Supreme Court later overturned that decision). Last September, he ruled that the A.C.A.’s mandate that employers cover a daily H.I.V. prevention pill called PrEP violated a company’s religious freedoms.

For now, employers will still be required to provide no-cost coverage for preventive services. But the Fifth Circuit is conservative-leaning, and the case could eventually end up at the Supreme Court as yet another challenge to the Obamacare health law.


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