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  • Washington Highlights

    5th Circuit Court of Appeals Rules on Preventive Care Mandate


    Gayle Lee, Director, Physician Payment & Quality
    For Media Inquiries

    The U.S. Court of Appeals for the 5th Circuit issued a June 21 decision (PDF) regarding whether the Affordable Care Act provision that requires private plans and Medicaid expansion programs to cover cost-sharing for preventive care services is unconstitutional. In its final opinion in Braidwood v. Becerra, the court stated, “Our decision today is something of a mixed bag.”

    Its ruling upheld the lower court’s decision that requiring coverage of services recommended by the United States Preventive Services Task Force is unconstitutional and stated that the plaintiffs in the case do not need to cover these preventive health services through their health plans. However, the 5th Circuit limited the scope of the relief to the plaintiffs only and overturned the nationwide injunction that the lower court had imposed, keeping the preventive care services requirement in effect for the majority of Americans. It also remanded the case to the district court to address some new questions raised during the appeal, specifically whether Health and Human Services Secretary Xavier Becerra properly ratified recommendations made by the Advisory Committee on Immunization Practices and guidelines issued by the Health Resources and Services Administration.  

    The AAMC and other organizations filed an amicus brief in May 2023 urging the 5th Circuit to protect access to preventive services [refer to Washington Highlights, May 5, 2023].