FORT WORTH, Texas (CN) — Health insurers no longer have to cover STD and cancer screenings, drug abuse counseling and other preventive services, a federal judge ruled Thursday, vacating longstanding Affordable Care Act coverage requirements.
U.S. District Judge Reed O’Connor, a George W. Bush appointee who in 2018 ruled the entire Affordable Care Act was unconstitutional only to be reversed by the U.S. Supreme Court, dealt another blow Thursday to former President Barack Obama’s landmark health insurance reform legislation.
He sided with a group of Texas Christians and two Christian-led Texas businesses who sued the federal government and the secretaries of the U.S. Health and Human Services, Labor and Treasury departments in March 2020.
The plaintiffs targeted the ACA’s mandate that health insurers and employers' self-funded health plans cover, without any deductibles or co-pays from their insured, drugs that prevent the transmission of HIV, screenings for cancer, diabetes, STDs and other conditions, and counseling for mental health and drug abuse issues.
Married plaintiffs Zach and Ashley Maxwell said in a first amended lawsuit, “They do not want or need free STD testing covered by their health insurance because they are in monogamous relationships with their respective spouses. And they do not want or need health insurance that covers Truvada or PrEP drugs because neither they nor any of their family members are engaged in behavior that transmits HIV.”
But they complained it was impossible for them to buy cheaper health insurance excluding this unwanted coverage.
The requirements for screening services stemmed from recommendations made by the U.S. Preventive Services Task Force, one of three agencies empowered by the ACA to decide what kinds of preventive care insurers must cover.
The American Cancer Society, joined by more than a dozen other groups that represent people suffering from chronic illnesses, filed an amicus brief in the case urging O’Connor to keep the mandatory screening coverage in place.
“Early detection yields two primary benefits,” they wrote. “First, and most importantly, early detection increases patients’ chances of survival and extends life expectancies. Second, early detection decreases the overall costs of treating illnesses over patients’ lifetimes.”
But an American Cancer Society spokesman said the judge’s ruling Thursday was expected because he agreed with the plaintiffs in September that the task force’s coverage requirements violated the appointments clause of the Constitution.
O’Connor determined the task force’s 16 volunteer members—doctors, nurses and psychologists who teach at U.S. medical schools—are federal officers because they exercise significant authority under U.S. law, so the appointments clause required them to be nominated by the president or confirmed by the U.S. Senate but they had been appointed without either of those steps in violation of Article II of the Constitution.
His latest ruling vacates the task force’s recommendations made after the ACA was enacted in March 2010.
The American Cancer Society, American Lung Association and other organizations who joined the friend-of-the-court brief criticized O’Connor’s order Thursday.
“This overly broad ruling will have sweeping negative implications for millions of Americans by once again erecting barriers to lifesaving preventive care. Numerous research studies have proven the benefits of these services,” the groups said in a statement.
“Whether it’s a doctor-recommended colonoscopy that finds a polyp before it becomes cancer, a low dose CT scan that identifies early stage lung cancer, a screening for diabetes that saves someone from developing potentially life-threatening kidney disease, a blood pressure test that alerts someone to their increased risk for a heart attack, quit smoking services that help someone end a tobacco addiction, or medication that prevents the contraction of HIV, these services are critical to people’s health,” they added.
Experts say health insurers will not immediately drop the preventive coverage because 2023 contracts are already in place but will consider changes for plans starting in 2024.
O’Connor’s order also goes against the wishes of 21 states, the majority led by Democrats, that cautioned him not to entirely nix the preventive care coverage mandate.
The Biden administration is expected to quickly appeal.
The plaintiffs are represented by Jonathan Mitchell, a former Texas solicitor general who helped write Senate Bill 8, the Texas Heartbeat Act.
Passed in September 2021, it barred abortions after about six weeks into a pregnancy and led providers to stop doing the procedure due to concerns with its enforcement mechanism, authorizing members of the public to sue anyone who performs or helps a woman get an illegal abortion for at least $10,000 in damages.
In the wake of the Supreme Court's June 2022 Dobbs decision overturning a constitutional right to abortion, Texas' Republican leaders passed a stricter law making it a first-degree felony with a max punishment of life in prison to do an abortion, except when pregnancy complications threaten the mother's life. SB 8 remains on the books.
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