Continued Legal Challenges to The Affordable Care Act

While the nation has been focused on the Supreme Court’s reversal of Roe v. Wade, a new courtroom drama has threatened to affect health care coverage for millions of Americans. 

In March 2023, a Texas judge struck down an Affordable Care Act provision that required private insurance companies to fully cover all preventive care services with no cost sharing for patients. This ruling came down after an initial lawsuit was filed in 2020, Braidwood Management Inc. v. Becerra, challenging this provision in the Affordable Care Act. The Texas ruling was set to apply nationwide and take effect immediately. 

The Affordable Care Act Preventive Care Provision

The Affordable Care Act (ACA) became law in 2010 and served as comprehensive health care reform that aimed to make health insurance more affordable. The law included several provisions related to health insurance markets: 

• Denied health insurance companies the right to refuse coverage or charge patients more based on pre-existing conditions.
• Allowed dependents to remain on their parent’s health insurance plan until the age of 26.
• Included more stringent rules on insurance companies’ ability to cancel policies.
• Removed lifetime limits on coverage of essential health services.
• Required insurance companies to cover preventive services at no cost to patients.

These no-cost preventive services include those with A and B ratings as set by the United States Preventive Services Task Force (USPSTF), an independent volunteer panel made up of national experts, as well as the Advisory Committee on Immunization Practices (ACIP), Health Resources and Services Administration (HRSA) – Women’s Preventive Services Initiative, and HRSA — Bright Futures for Children. 

The ACA has been a political hot topic since its inception under the Obama Administration. Opinions on its viability, implications of care, and cost measures have been widely debated and the law has been challenged in court more than 2,000 times since its enactment. Despite varying opinions, the preventive services provision remains amongst the most popular with 62% of Americans saying it is very important to them that the ACA requires insurance companies to cover the cost of preventive services.

Braidwood Management Inc v. Becerra

In this most recent legal challenge to the ACA, the plaintiff, Braidwood Management, argued that the volunteer panels tasked with issuing recommendations on what preventive care must be covered under law, violated the Constitution as they were not federally appointed members confirmed by the Senate. Additionally, the plaintiffs argued that the specific coverage of PrEP, an HIV prevention medication, violated the Religious Freedom Restoration Act, a law preventing the government from imposing burdens on individual religious beliefs. 

On March 30th, 2023, Texas District Court Judge O’Connor, issued a ruling striking down the ACA preventive services provision, blocking the federal government’s ability to require insurance companies to cover any additional services recommended by the USPSTF since March 2010. The ruling did not affect recommendations given by the other organizations including ACIP and HRSA. 

Current Case Status and Implications

On May 15th, 2023, a federal appellate court issued a temporary stay in response to an appeal from the Biden Administration. This prevented the March 30th ruling from taking effect. The parties were also asked to come to an agreement on how much of the mandate should be put on hold until the appeals process finished. 

On June 12th, 2023, a deal was reached to guide allowable actions while the appeal is underway. The requirement for health plans to cover preventive care at no cost to patients will continue, leaving the provision mostly intact. However, an exemption was placed for the small businesses and individuals challenging the provision — they will be allowed to use a health plan that does not cover these services. The appellate court is still expected to rule on the constitutionality of the ACA provision later this year. 

As of 2022, more than 150 million people receive health coverage from private insurance companies. That is 150 million people who can receive preventive services at no additional cost to them. This coverage has resulted in increases in blood pressure and cholesterol screenings, HPV and flu vaccinations, cancer screenings, and HIV preventive care. If the March 30th ruling were to be upheld, this would have serious access and affordability implications for vulnerable populations who rely on comprehensive plans to meet their health care needs. The cost burdens would likely fall on those least able to afford it, affecting one of the major goals of the ACA, to increase affordability of health care services. Continue to keep an eye on this case. It is likely not the last legal challenge we will see to the Affordable Care Act.