Jun 6, 2023 - Health

Appeals court to weigh fate of ACA preventive care requirement

Illustration: Sarah Grillo/Axios

A federal appeals court will hear arguments today on whether to lift a freeze on a decision halting the Affordable Care Act's requirement that employers fully cover the cost of specified preventive health care services.

Driving the news: If the New Orleans-based U.S. 5th Circuit Court of Appeals affirms the ruling, it could eliminate cost-free coverage for certain cancer screenings, behavioral counseling, HIV prevention and other services recommended by the U.S. Preventive Services Task Force.

  • Legal experts say a ruling could come as soon as this week.

State of play: The three-judge panel that will preside over the court hearing is comprised of Judges Edith Brown Clement and Leslie Southwick, two George W. Bush appointees, and Judge Stephen Higginson, an Obama appointee.

  • The Justice Department argues the public will be harmed unless the lower court ruling is stayed.
  • Regardless of the outcome, the decision is expected to be appealed to the Supreme Court.

What we know: A ruling in favor of plaintiffs challenging the ACA requirement would create a "free-for-all for insurance companies," said Andrew Twinamatsiko, associate director of the O'Neill Institute at Georgetown Law School.

  • "There would no longer be federal legal obligation for them to cover those services without cost-sharing," he said.
  • Employers and insurers could then pick and choose which services to cover, and potentially make patients would first have to meet a deductible before the benefit kicks in.

Catch up quick: The 5th Circuit last month froze a U.S. district court ruling that struck down the ACA's preventive health care coverage requirement nationwide.

  • U.S. District Court Judge Reed O'Connor had ruled that the preventive services task force is not appointed by the Congress, and thus lacks the authority to say which services insurers must cover.
  • The case was originally brought by plaintiffs arguing a requirement that employers cover the HIV prevention medication known as PrEP violates the Religious Freedom Restoration Act.

Go deeper: Court ruling on HIV meds could have sweeping implications for preventive care

Go deeper