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  • Washington Highlights

    Federal Judge in Texas Rules on Preventive Services Coverage Under ACA


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

    On Sept. 7, Judge Reed O’Connor of the United States Northern District Court of Texas ruled that the current process for determining the kind of preventive services that must be fully covered by private health insurance under the Affordable Care Act (ACA) (P.L. 111-148) is unconstitutional.

    Under a provision of the ACA that went into effect in late 2010, many services considered preventive are covered without a copayment or deductible from the patient. To be on the list of covered preventive services, vaccines, screening tests, drugs, and services must have been recommended by one of three groups of medical experts. In the ruling, O’Connor concluded that requiring coverage of the services recommended by the U.S Preventive Services Task Force (one of the three groups) violated the Constitution because its members are not appointed by the president or confirmed by the Senate. The judge dismissed claims involving the other two medical expert groups.

    This ruling could jeopardize access to cancer screenings (e.g., colonoscopies and mammograms), cholesterol drugs, screenings for diabetes and depression, and other services. Another portion of O’Connor’s ruling stated that a requirement that preexposure prophylaxis (commonly known as PrEP) drugs that prevent HIV be covered with no cost to the patient violates the religious freedom of an employer who is a plaintiff in the case. The judge has asked for further briefing as to the nature of relief to be ordered by the court and also as to claims relating to coverage of contraception.

    The AAMC, along with the American Public Health Association and 20 health policy experts, submitted an amicus brief to the court in February supporting the provision in the ACA that allows for coverage of preventive health services at no cost to consumers. The AAMC also signed a joint statement with 60 leading health care organizations expressing concerns that the lawsuit could jeopardize coverage of these services [refer to Washington Highlights, Aug. 5]. The case is likely to be appealed to the 5th U.S. Circuit Court of Appeals.