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Federal judge’s ruling threatens preventive care coverage in ACA

A federal judge in Texas agreed Wednesday with the plaintiffs, a handful of employers in the state, that requiring insurers to cover the costs of HIV pre-exposure prophylaxis (PrEP) medications violated their religious rights, taking away indeed a central principle. of the Affordable Care Act (ACA).

Under the ACA, most health plans must pay for a variety of preventive services — including cancer screenings, well-child visits and routine immunizations — with no share of cost.

The ruling was issued by Justice Reed O’Connor, the same conservative judge who ruled the ACA unconstitutional in 2018 before the Supreme Court reversed its decision in 2021, and is sure to provoke a backlash from organized medicine. It is also expected to be appealed by the federal government.

O’Connor’s decision came in response to Management of Braidwood v. Calf (before Kelley v. Calf) in which the plaintiffs argued that the ACA’s requirement that insurers pay for certain preventive services was unconstitutional because it encouraged behavior that conflicted with their personal and religious beliefs. While the lawsuit would remove the mandate for all preventive services, some plaintiffs seemed more concerned with services related to sexual and reproductive health.

One plaintiff, Steven Hotze, MD, a family medicine physician according to The Texas Tribuneargued in the complaint that he did not want to pay for employer insurance that includes PrEP coverage, “because these drugs facilitate or encourage homosexual behavior” and are contrary to his “sincere religious beliefs.”

Four plaintiffs also argued that they “do not need or want contraceptive coverage in their health insurance… [and t]Hey, you don’t want or need free STDs. [sexually transmitted disease] tests covered by their health insurance because they are in a monogamous relationship with their respective spouses,” the suit says.

“Each of these plaintiffs is a Christian and unwilling to purchase health insurance that subsidizes abortion contraception or PrEP medications that encourage and facilitate homosexual behavior,” the suit continued.

The lawsuit also argued that the preventive services mandate is unconstitutional because it is based on requirements developed by federal and non-federal employees, for example, the Advisory Committee on Immunization Practices and the US Preventive Services Task Force, whose members were not elected. by the President nor were they confirmed by the Senate.

The 2020 lawsuit was filed by Jonathan Mitchell, an attorney in Austin, Texas, who led the way in establishing Texas’ 6-week abortion ban, according to The Tribune.

Lisa Lacasse, president of the American Cancer Society’s Cancer Action Network, criticized O’Connor’s decision.

“Before the passage of the Affordable Care Act, high costs and unclear coverage were repeatedly cited among the top reasons people delayed or skipped screening tests. We can’t risk going back to a system where each individual has to interpret their complex insurance plans to determine if a recommended individual will be covered for a mammogram or to determine how much their colonoscopy may cost,” Lacasse said in a news release.

“We strongly urge the government to quickly appeal this ruling. Cancer patients, survivors and all those at risk of the disease cannot face undue barriers to the cost and coverage of these services,” he added.

The American Medical Association and dozens of other medical groups warned in July that “[w]With an adverse ruling, patients would lose access to vital preventive health care services, such as screening for breast cancer, colorectal cancer, cervical cancer, heart disease, diabetes, preeclampsia, and hearing, as well as access to Critical immunizations to maintain a healthy life. population.”

Reversing this access, the groups asserted, “would reverse important progress and make it more difficult for doctors to diagnose and treat diseases and medical conditions that, if caught early, are significantly more manageable.”

joy peace, Washington editor, contributed to this article.

  • Shannon Firth has been reporting on health policy as the Washington correspondent for MedPage Today since 2014. She is also a member of the site’s research and business reporting team. To follow


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