Lawyers reached an agreement Monday to preserve the Affordable Care Act’s mandate to require health plans to provide preventive care to patients at no cost.
A district court in Texas ruled in March that some of the requirements were unconstitutional.The decision, effective immediately, means insurers are no longer required to cover certain types of preventive care, including pills to prevent HIV transmission
The Fifth Circuit Court of Appeals put the ruling on hold last month, reviving provisions of the health law. The appeals court also asked the two parties — a group of Texas residents and businesses challenging the law, and the Biden administration, which defends it — to reach a compromise on how much authorization should be set aside while weighing its powers. Decide.
The agreement they struck left almost entirely in place requiring the vast majority of health plans to continue providing preventive care for free. The agreement includes an exemption for small businesses and individuals who challenge the provision; those entities would be allowed to use plans that don’t cover all preventive services if they can find a health insurer that offers the service.
The appeals court is expected to rule on the constitutionality of the preventive health mandate later this year, but the attorneys’ agreement still needs to be approved.
Health policy experts have described the mandate as one of the most transformative policies in the health law, known as Obamacare, because it prevents disease progression and later cost increases. It’s also popular, with 62% of the public recently saying it’s “very important” to keep it in place.
Before the passage of the Affordable Care Act in March 2010, patients sometimes faced huge bills for preventive care like birth control or colonoscopies. Studies show that since the order went into effect, more Americans have received blood pressure screenings, cholesterol screenings and flu vaccinations.
In March, Judge Reed O’Connor of the U.S. District Court for the Northern District of Texas ruled that part of the mandate was unconstitutional because an independent panel advised the government on which benefits to cover but didn’t have the proper authority to do so.
Judge O’Connor’s ruling did not revoke the entire preventive services mandate, but said it should not cover services recommended by the U.S. Preventive Services Task Force since 2010.
The newer service includes three types of screenings: one for anxiety disorders in children, another for unhealthy substance use and a third for weight gain in pregnant women. The mission also included a recommendation that people at high risk of HIV take PrEP, a daily pill that is highly effective at preventing the spread of the virus.
The challengers in the case objected to covering PrEP, notably arguing that the drug might “encourage homosexual behavior or intravenous drug use.”
The deal likely won’t have much of a practical impact on most Americans. When the district court delivered its initial ruling in March, many health plans announced they would not change their benefits.
Health plans often have policies that span a full year, and it’s unusual for them to change their members’ benefits in the middle of a contract. Insurance companies may be reluctant to eliminate a popular benefit that, in some cases, could save them money by preventing serious illness later on.
Matt Eyles, president of AHIP, the trade group that represents health insurers, said in a statement shortly after the initial ruling that there was “no immediate interruption of care or coverage.”
The Blue Cross Blue Shield Association, which has health plans across the country, said in March that it would “strongly encourage its members to continue to have access to these services to facilitate their continued wellbeing.”
