Fifth Circuit Grants Stay of ACA Preventive Health Services Mandate During Braidwood Appeal

The U.S. Court of Appeals for the Fifth Circuit has stayed the trial court’s ruling in Braidwood v. Becerra, pending appeal by the U.S. government, by the parties’ agreement. Braidwood concerns the constitutionality of the preventive health services mandate of the Affordable Care Act (ACA). More specifically, the case addresses the legality of the insurance coverage required by the U.S. Preventive Services Task Force (USPSTF) recommendations.

A group of employers and individuals initiated this lawsuit, claiming that the entire preventive care mandate is unconstitutional. The plaintiffs also argue that a 2019 USPSTF recommendation requiring employers to provide coverage for HIV preexposure prophylaxis (PrEP) under their health insurance plans violates the Religious Freedom Restoration Act (RFRA).

The trial court ruled that requiring plan coverage of PrEP violated RFRA.

The court further found that the members of the USPSTF were not appointed according to any constitutional authority and thus had no legal authority to require employers to cover certain preventive health services in their insurance plans. As a result, the court vacated all HHS, IRS, and DOL actions taken after March 23, 2010, to implement or enforce preventive health services as recommended by USPSTF.

However, the Fifth Circuit’s stay of the trial court ruling will allow the USPSTF preventive service recommendations and related coverage requirements to remain in effect pending the U.S. government’s appeal. In return, the government has agreed to refrain from seeking penalties or taking any enforcement action against the plaintiffs’ employers or insurers for refusing to cover mandated preventive services while the stay is in effect. The agreement avoids, at least for now, the trial court’s expansive invalidation of the federal agency actions related to USPSTF recommendations dating back to March 23, 2010.

Employers should know that Braidwood does not impact all preventive health services, despite the stay. For example, it does not affect any USPSTF recommendations the federal agencies implemented before March 23, 2010. The ongoing litigation also does not affect preventive services arising from the Health Resources and Services Administration (HRSA) guidelines for women’s and children’s preventive services or the Advisory Committee on Immunization Practices (ACIP) immunization recommendations.

The case is Braidwood v. Becerra2023 WL 2703229 (N.D. Tex. 2023) (Docket: Unpublished Order (5th Cir. June 13, 2023)).

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