Federal Trial Court Rules ACA’s Preventive Care Mandate Unconstitutional | News and Publications
On March 30, 2023, a federal district court judge in Texas struck down a provision of the Patient Protection and Affordable Care Act (“ACA”) that required private health insurers and insurance plans -group health to provide coverage for certain preventive care services at no cost to patients. The court’s decision took effect immediately and applies nationwide. On March 31, the US Department of Justice appealed the court’s decision.
The ACA relies on three groups of health care experts to advise the government on the preventive services that should be covered by group health plans. The district court ruled that one of those committees, the United States Preventive Services Task Force (“PSTF”), lacked the constitutional authority to determine what benefit plans should cover. The court based its decision (the “Texas decision”) largely on the fact that the PSTF is a body of private experts who serve in a pro bono capacity and that such volunteer status violated the appointment clause of the Constitution of UNITED STATES. Pursuant to this alleged violation, the court found all relevant recommendations issued by the PSTF to be unconstitutional and retroactively struck down all such recommendations.
What are PSTF Preventive Care Services?
The PSTF recommends various preventive care services. For example, since 2010, the PSTF has endorsed several types of preventative care, including treating anxiety in children, drug use, diabetes, osteoporosis, colon cancer, skin cancer, lung cancer and breast cancer. Since 2010, the PSTF has also recommended PrEP, which is a very effective drug for preventing HIV transmission. Under the Texas ruling, group health plans are not required to follow the PSTF’s post-2010 recommendations.
Which preventive care services are not affected?
The Texas decision would not change coverage requirements for vaccines (including the Covid-19 vaccine) recommended by the Advisory Committee on Immunization Practices (“ACIP”), women’s health services (including all types of contraception) recommended by the Health Resources and Services Administration (“HRSA”) or services for children and young adults recommended by Bright Futures. These preventive care categories and other preventive care requirements based on ACIP and HRSA recommendations are unaffected by the Texas decision because, unlike the PSTF, ACIP and HRSA are under the direct control and supervision of the United States Department of Health and Human Health. Services. The Texas decision concluded that such oversight and oversight made recommendations made by the ACIP and HRSA under the appointment clause of the United States Constitution appropriate.
Impact of the Texas District Court ruling
Effective March 30, 2023, unless Texas’ decision is stayed pending appeal, group health insurance plans are no longer required to provide free coverage for PSTF-recommended preventative care effective of March 23, 2010.Following the Texas decision, in the absence of a stay or other relief, group health plans can be modified to begin charging co-payments, coinsurance and deductibles for recommended preventative care services by the applicable PSTF. Employers and insurers may be reluctant to immediately withdraw a benefit that is the subject of a future legal challenge.
The United States federal government appealed the Texas decision on March 31, 2023. Along with the appeal, the United States is very likely to seek a stay of the Texas decision to prevent it from entering into force until the end of the appeal process. The U.S. must seek such a stay no later than May 29, 2023. If the appeals court grants the U.S. stay request, it would put Texas’ decision on hold and put the preventive care mandate, as than it was prior to the Texas ruling, again in effect. If a stay is not granted, group health plans will not be required to provide the PSTF-recommended preventive care services that were overridden by the Texas decision.
If you have any questions or need assistance, please contact a Kutak Rock member Benefits practice group.
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