Texas Court Invalidates ACA’s Free Preventive Care Requirement Nationwide

A Texas federal judge has struck down the portion of the Affordable Care Act (ACA) that requires insurers and employers to provide free preventative care services, such as contraception, as well as screenings for cancer, heart disease, HIV, and other diseases. The judge also found in his decision that requiring coverage of PrEP for HIV violates the Religious Freedom Restoration Act (RFRA). The ruling in Braidwood Management v. Becerra, which the court issued on March 30, 2023, applies nationwide.

Two Christian businesses and six individuals filed this suit to challenge the legality of the preventative care mandates on constitutional grounds and medication to treat HIV on religious grounds. In September 2022, the judge initially ruled partially in favor of the plaintiffs and partially in favor of the U.S. Department of Health and Human Services (HHS).

The March ruling follows up on that ruling, after the judge considered arguments from both sides of the dispute. Most importantly, the ruling vacates any federal agency action that occurred since March 23, 2010, to implement the portion of its mandate of preventive services recommended by the U.S. Preventive Services Task Force (USPSTF). As a result, while private health plans and Medicaid expansion plans still must cover preventive services with USPSTF recommendations that predated March 23, 2010, they do not have to cover any USPSTF-recommended services that occurred after that date.

The court rejected Braidwood’s argument that Advisory Committee for Immunization Practices (ACIP) and Health Resources and Services Administration (HRSA)-recommended services also were unconstitutional. Therefore, the ACA mandate for these services, which includes a range of vaccinations and preventive services for adults and children, including contraceptives, remains in place.

The Department of Justice (DOJ) appealed the decision to the U.S. Court of Appeals for the Fifth Circuit. Braidwood filed a cross-appeal seeking an even more expansive judgment in its favor than it already has received. Moreover, the DOJ has filed motions requesting that the federal district court judge stay his ruling and the appellate court stay the district court’s ruling while considering the appeal. Neither court has issued a ruling on DOJ’s requests for stays.

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