'Nothing Short of Catastrophic': Federal Judge Strikes Down ACA Preventative Care Provision

A ruling handed down by a U.S. district judge on Thursday will threaten a range of lifesaving preventative healthcare services for more than 150 million people, legal experts and advocates said, as the decision challenged the legality of a federal task force that enforces coverage for the services.

Judge Reed O'Connor, a Bush appointee who sits on the U.S. District Court for the Northern District of Texas, ruled that insurance companies do not have to comply with preventative care recommendations made by the U.S. Preventive Services Task Force (USPSTF), which was established by a key provision in the Affordable Care Act (ACA), also known as Obamacare.

O'Connor ruled that the appointments of members of the task force violate the Appointments Clause in the U.S. Constitution and said that violation "invalidates its power to enforce anything against anyone nationwide," according toSlate journalist Mark Joseph Stern.

The USPSTF has issued recommendations for a wide range of preventative care services, including screenings for breast cancer, colorectal cancer, cervical cancer, and diabetes; interventions and tests for pregnant patients; anxiety screenings for children and adolescents; and pediatric vision tests.

Under the ACA, insurance companies are required to cover those services, but following O'Connor's ruling coverage will no longer be mandated.

The decision is "nothing short of catastrophic to the U.S. healthcare system," said Stern.

The ruling stemmed from a lawsuit filed in 2020 by Christian employers who objected to paying for services such as contraceptives and preexposure prophylaxis (PrEP), to prevent HIV transmission.

In September, O'Connor ruled that coverage for PrEP violated the companies' religious freedom in a decision that one doctor who specializes in HIV treatment condemned as "disgusting and inhumane" and likely "driven solely by homophobia and transphobia."

The companies are being represented by Texas attorney Jonathan Mitchell, who helped develop the state's abortion ban that allows private citizens to sue anyone who "aids or abets" a person who obtains abortion care.

More than 150 million Americans who have private health insurance have coverage for preventative care under the ACA, as well as approximately 20 million Medicaid and 61 million Medicare recipients.

Last July, as O'Connor was considering the case, titled Braidwood Management Inc., vs. Xavier Becerra, national health organizations including the American Medical Association, the American Academy of Pediatrics, and the American College of Obstetricians and Gynecologists warned that a ruling in the plaintiffs' favor would "reverse important progress and make it harder for physicians to diagnose and treat diseases and medical conditions that, if caught early, are significantly more manageable."

"With an adverse ruling, patients would lose access to vital preventive healthcare services, such as screening for breast cancer, colorectal cancer, cervical cancer, heart disease, diabetes, preeclampsia, and hearing, as well as access to immunizations critical to maintaining a healthy population," the organizations wrote. "Our patients cannot afford to lose this critical access to preventive healthcare services."

The Biden administration is expected to appeal O'Connor's ruling, and since insurance coverage contracts typically run through the end of the year, coverage will likely not change for many before 2024.

If upheld, the ruling will deal "a devastating blow to American public health," said University of California law professor Jennifer Oliva.

Last year, a Morning Consult poll found that at least 2 in 5 Americans were not willing to pay out-of-pocket for preventative services currently covered by the ACA.

O'Connor previously ruled in 2018 that the ACA should be struck down in its entirety, but that ruling was overturned by the U.S. Supreme Court.

The judge's latest ruling offers "another reason why we need Medicare for All," said the Debt Collective. "The milquetoast ACA is being dismantled before our eyes. There is no reason not to fight for real solutions when the non-solutions stand no better chance."