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Unpacking efforts to overturn the ACA's preventive care mandate, and Biden's appeal

by John R. Fischer, Senior Reporter | April 03, 2023
Insurance
A federal judge's strike down of ACA mandates for free coverage of preventive care services will affect recommendations made for medical imaging guidelines for when to assess patients for cancers and other diseases.
The Biden Administration has filed an appeal with the Fifth Circuit over a federal judge's decision to nationally invalidate Affordable Care Act mandates guaranteeing free coverage for certain cancer screenings and preventive care services. Healthcare legal experts agree, saying that without them, hospitals will face greater challenges in preventing patients from deterring or delaying care, which puts them at greater risk of late-stage diagnoses that are harder to treat.

The U.S. Preventive Services Task Force, a panel of the ACA, recommends types of preventive care that insurers should cover at no cost for roughly 150 million people with private health coverage, as well as those using the ACA marketplace.

In a 2020 legal challenge, Braidwood v. Becerra, eight individuals and two businesses, all from Texas, said these mandates are unlawful because the USPSTF members who made them were not appointed by the president, violating the appointments clause of the U.S. constitution. They also said they should not have to cover HIV-preventive measures, such as PrEP, STD testing and contraceptives, as doing so violates their religious rights under the Religious Freedom Restoration Act of 1993.

“Coverage for those services violates their religious beliefs by making them complicit in facilitating homosexual behavior, drug use, and sexual activity outside of marriage between one man and one woman," wrote Judge Reed O'Connor, of the U.S. District Court for the Northern District of Texas, in his ruling.

O'Connor originally sided with the plaintiffs in September, but waited until March 30 to determine that the verdict should apply nationwide, reported Reuters.

Which services are at risk?
The ruling applies to any mandates made after the ACA's enactment in 2010, which include screenings for anxiety in children, unhealthy drug use and weight gain in pregnant women, and PrEP, a daily pill for preventing the transmission of HIV, reported The New York Times.

While mandates made prior to 2010, such as mammograms for breast cancer, will not lose coverage, insurers are no longer obligated to abide by new guidance issued by the USPSTF on when it is necessary to conduct those services. For example, they will not have to cover CT colonography and stool-based tests as colorectal screenings for patients starting at age 45, a recommendation made in 2021 in response to what the Task Force said was a rise in young-onset colorectal cancer.

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