Impact of the Texas Federal Court Ruling on the ACA No-Cost Preventive Services Mandate Explained

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ACP calls for reversal of the decision to ensure patients do not lose access to preventive services

April 21, 2023 (ACP) — The American College of Physicians is deeply concerned by a Texas federal judge's ruling that could eliminate the Affordable Care Act (ACA) requirement that insurers cover recommended preventive care at no extra cost to patients.

The ruling threatens access to cancer screenings, mental health screenings and heart disease and hypertension screenings, among other services. An estimated 100 million people with private insurance received ACA-covered preventive services in 2018, according to the Health System Tracker from the Peterson Center on Healthcare and KFF (formerly the Kaiser Family Foundation).

“ACP calls for this decision to be reversed before our patients begin losing access to preventive services. Instead of attacking the coverage that patients have, we should be looking for ways to bolster the ACA and increase access to care,” said Dr. Ryan D. Mire, president of ACP. “With the increased subsidies for premiums for ACA plans, we have seen record enrollment over the last year. We should be looking for other ways to work toward universal coverage, rather than stripping away care from patients.”

As explained by KFF, in September, Judge Reed O’Connor of the U.S. District Court in the Northern District of Texas concluded that aspects of the ACA provision requiring most private health plans to cover a range of preventive services without cost-sharing for enrollees were unconstitutional and violated religious rights. In a March 30 ruling, Judge O’Connor issued a remedy that strikes down part of the ACA requirement for no-cost coverage of preventive services recommended or updated by the U.S. Preventive Services Task Force on or after March 23, 2010.

At a briefing about the ruling, Larry Levitt, executive vice president for health policy at the KFF, noted, “As sweeping as the ruling is, it does not completely and immediately wipe out preventive services coverage under the ACA. … The ruling also only applies to updates or new recommendations since March 2010, when the ACA was enacted. … It would effectively lock in place coverage of evidence-based prevention with no cost-sharing from 13 years ago.”

For example, he said, the ruling would eliminate the requirement to cover types of preventive care, such as statins to prevent heart disease, lung cancer screening and preexposure prophylaxis treatment to prevent infection with HIV, which are all newer recommendations from the U.S. Preventive Services Task Force.

What happens now if the ruling is not put on hold by a higher court? “It's very likely that insurers will still cover these preventive services,” Levitt said. “But insurers may very well charge patient cost-sharing for these services. … In most cases, [this will] not happen immediately because insurance contracts are in place for the calendar year. … effects on coverage are likely to take effect starting next calendar year rather than immediately.”

Meanwhile, the mandates to provide certain kinds of preventive care per older guidelines at no extra cost will remain in place. These mandates cover mammography, colorectal cancer screening, cervical cancer screening and chemotherapy prevention for breast cancer in patients at high risk, according to Alina Salganicoff, a senior vice president at KFF.

Levitt said the mandate to provide recommended vaccinations at no extra charge will also remain in place. States could take action, he said, but “[t]here are real limits to what states can do here. … [S]elf-insured employer plans, which cover most people with private insurance, cannot be touched by state regulation.”

On April 13, the Justice Department requested a partial stay of the ruling, pending appeal. It is hard to judge what will happen at the appeal court level or the Supreme Court, said Laurie Sobel, an associate director at KFF.

In the big picture, Levitt said, it is important to understand the limitations of the ruling regarding the ACA. “Previous cases to the ACA threatened the very existence of the law and its fundamental protections,” he said. “This case does not do that. It would strike down a portion of the law, albeit a very popular one that's used by a lot of people.”

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