Judge Strikes Down ACA's Required Coverage Of Preventive Care

[Ian S]

Besides those insured under the ACA, this decision, if upheld, will affect millions more Americans including those of us on Medicare https://www.forbes.com/sites/alison...ings-pregnancy-prep-and-more/?sh=1d885fee7b74 :

A federal judge in Texas struck down a provision of the Affordable Care Act that required coverage for a range of preventive services—including for cancer screenings, medications and more—ruling the task force members tasked with enforcing those preventive services were unlawfully appointed.

 

[Aerides]

While this is alarming on face value, an important point from the article (bolds mine):

"The Biden Administration is expected to appeal O’Connor’s ruling, which means there’s still the possibility a higher court could overturn it. Insurance coverage contracts generally run through the end of the year, making any changes to insurance policies and what services they cover unlikely before 2024. That means if the case is reversed when it’s appealed, there ultimately could be little impact to Americans’ coverage—though it still remains to be seen how higher courts, including potentially the Supreme Court, will respond to the case."

And this is just another one of those things that people don't much think about re the ACA - it's all insurance, employer, Medicare, as the larger law offers far more than just the exchange programs and subsidies.

 

[athena53]

That's really sad. Whatever the legal basis, in real dollar terms it probably means healthcare costs will increase (beyond inflation) as people skip preventative testing and show up with advanced stages of diseases. Colonoscopies are bad enough- who can and would fork out $2,000-plus out of pocket for one in addition to the nasty prep?

 

[copyright1997reloaded]

Long article, with pretty much no information as to the legal questions involved.

It might have been nice to have a link to the court docket (which would show not only the ruling but also the legal arguments from both sides), but I guess that is too much to ask of Journalists these days.

 

[Plantman]

I don't know about you, but I'm tired of these one off judges whose decisions affect millions of people across the country. Their authority seems to be oversized to me. There are over 850 federal judges. It just doesn't seem right to me.

 

[Walt34]

[mod hat on]

Careful....

[mod hat off]

 

[RobbieB]

I'm not worried. I'm sure this will end well.

I'm sure that the old "words of wisdom" will apply.

Because everyone should know the truth of;

"An ounce of prevention is worth a pound of cure."

 

[Dtail]

Just idiotic.
If one of these cancers came home to roost, his thoughts might be different.

 

[ShokWaveRider]

Just idiotic.
If one of these cancers came home to roost, his thoughts might be different.

I doubt it as he and his family get top notch medical healthcare at no out of pocket cost. My neighbor is a retired judge and he and his wife get free healthcare for life. Even his Medicare Supplemental plan premiums are covered.

 

[pb4uski]

+1 Those who do not learn from history are destined to repeat it. 0 for 2? I think so.

This isn’t O’Connor’s first major ruling concerning the ACA, as the judge—a George W. Bush appointee—also invalidated the ACA in its entirety in 2018, striking it down as unconstitutional. That ruling was ultimately overturned by the Supreme Court.

 

[Dtail]

I doubt it as he and his family get top notch medical healthcare at no out of pocket cost. My neighbor is a retired judge and he and his wife get free healthcare for life. Even his Medicare Supplemental plan premiums are covered.

True, true. Forgot about that aspect and can't say anymore thoughts on this one.

 

[MichaelB]

A bit more info from Kaiser Health https://khn.org/news/podcast/podcas...-preventive-care-judicial-blow-march-30-2023/

In 2018, O’Connor held that the entire ACA was unconstitutional — a ruling eventually overturned by the Supreme Court. Now the judge has found that part of the law’s requirement for insurers to cover preventive care without copays violates a federal religious freedom law.

./.

Thursday’s decision out of Texas affects health plans nationwide and is expected to disrupt the health insurance market, which for years has provided preventive care without cost sharing under the ACA. Even if the decision survives a likely appeal, insurers could continue offering the popular, generally not-so-costly benefits, but they would no longer be required to do so.

The decision, which found that the U.S. Preventive Services Task Force cannot mandate coverage requirements, hinges on religious freedom objections to plans covering PrEP, the HIV medication, alongside other preventive care.

 

[jim584672]

There are currently 14 states which mandate the same preventative service coverage without cost sharing to individual market enrollees as the ACA itself: California, Colorado, Connecticut, Delaware, Maine, Maryland, Minnesota, New Mexico, New Jersey, New York, Oregon, Virginia, Vermont and Washington State.

https://www.commonwealthfund.org/bl...-services-benefit-jeopardy-what-can-states-do

 

[USGrant1962]

Long article, with pretty much no information as to the legal questions involved.

It might have been nice to have a link to the court docket (which would show not only the ruling but also the legal arguments from both sides), but I guess that is too much to ask of Journalists these days.

This article has links to the docket and decision. https://news.bloomberglaw.com/healt...ive-services-mandate-blocked-by-federal-judge

It seems to hinge on a previous decision that declared the recommendation committee to be unlawful because appointments weren't subject to Senate confirmation and recommendations have no elected official oversight. This decision goes to the remedy.

In September, O’Connor held that the PSTF, which determines some of what qualifies as covered preventive measures under the ACA, can’t validly do so because its members aren’t subject to Senate confirmation and their recommendations aren’t reviewed by constitutionally appointed government officials.

Whether you like ACA or not, it was certainly a sloppily written law.

 

[EastWest Gal]

I don't know about you, but I'm tired of these one off judges whose decisions affect millions of people across the country. Their authority seems to be oversized to me. There are over 850 federal judges. It just doesn't seem right to me.

This is not R vs D. This is not political. This is one single person deciding to reverse long-fought-for legislation, just because they are power-tripping. This is cherry-picking judges, many who are not qualified. It makes me want to go to law school and become a judge. After 30 years of saving the lives of babies and children, I think I know right from wrong, more than some of these judges do.

It’s about saving lives and improving the quality of life for all of us.

Please don’t bring Porky in too soon. I’m crying over this.

 

[pb4uski]

It seems that the plaintiffs and the judge are looking to use a technicality in admitedly sloppily crafted legislation to try to subvert things because things didn't go as they wanted.

I suspect that the services that this judge struck down were commonplace even before ACA because prevention makes economic sense.

 

[Dtail]

It seems that the plaintiffs and the judge are looking to use a technicality in admitedly sloppily crafted legislation to try to subvert things because things didn't go as they wanted.

I suspect that the services that this judge struck down were commonplace even before ACA because prevention makes economic sense.

Kind of a revenge tactic due to losing the ACA battle over and over.

 

[Montecfo]

That's really sad. Whatever the legal basis, in real dollar terms it probably means healthcare costs will increase (beyond inflation) as people skip preventative testing and show up with advanced stages of diseases. Colonoscopies are bad enough- who can and would fork out $2,000-plus out of pocket for one in addition to the nasty prep?

Most preventive screenings cost more to administer than the diseases they diagnose or prevent.

That is why most commercial insurance did not cover as much as ACA mandated.

 

[youbet]

I suspect that the services that this judge struck down were commonplace even before ACA because prevention makes economic sense.

Have any services actually been struck down at this point?

 

[MichaelB]

From Healthcare.Gov, following are the ACA preventive services (here). These are all in 2023 ACA compliant plans, so this ruling, if implemented, would allow insurers to not offer some or all beginning 2024. Whether they do is another matter.

It seems intuitive that screenings are cost effective for the entire population and I would love to see any hard data showing otherwise.

Preventive care benefits for adults

All Marketplace health plans and many other plans must cover the following list of preventive services without charging you a copayment or coinsurance. This is true even if you haven’t met your yearly deductible.

Notice:
IMPORTANT
These services are free only when delivered by a doctor or other provider in your plan’s network.
- Abdominal aortic aneurysm one-time screening for men of specified ages who have ever smoked
- Alcohol misuse screening and counseling
- Aspirin use to prevent cardiovascular disease and colorectal cancer for adults 50 to 59 years with a high cardiovascular risk
- Blood pressure screening
- Cholesterol screening for adults of certain ages or at higher risk
- Colorectal cancer screening for adults 45 to 75
- Depression screening
- Diabetes (Type 2) screening for adults 40 to 70 years who are overweight or obese
- Diet counseling for adults at higher risk for chronic disease
- Falls prevention (with exercise or physical therapy and vitamin D use) for adults 65 years and over, living in a community setting
- Hepatitis B screening for people at high risk, including people from countries with 2% or more Hepatitis B prevalence, and U.S.-born people not vaccinated as infants and with at least one parent born in a region with 8% or more Hepatitis B prevalence.
- Hepatitis C screening for adults age 18 to 79 years
- HIV screening for everyone age 15 to 65, and other ages at increased risk
PrEP (pre-exposure prophylaxis) HIV prevention medication for HIV-negative adults at high risk for getting HIV through sex or injection drug use
- Lung cancer screening for adults 50 to 80 at high risk for lung cancer because they’re heavy smokers or have quit in the past 15 years
- Obesity screening and counseling
- Sexually transmitted infection (STI) prevention counseling for adults at higher risk
- Statin preventive medication for adults 40 to 75 at high risk
- Syphilis screening for adults at higher risk
- Tobacco use screening for all adults and cessation interventions for tobacco users
- Tuberculosis screening for certain adults without symptoms at high risk

Immunizations for adults — doses, recommended ages, and recommended populations vary:
Chickenpox (Varicella)
Diphtheria
Flu (influenza)
Hepatitis A
Hepatitis B
Human Papillomavirus (HPV)
Measles
Meningococcal
Mumps
Whooping Cough (Pertussis)
Pneumococcal
Rubella
Shingles
Tetanus

 

[Sojourner]

I don't know about you, but I'm tired of these one off judges whose decisions affect millions of people across the country. Their authority seems to be oversized to me. There are over 850 federal judges. It just doesn't seem right to me.

This is not R vs D. This is not political. This is one single person deciding to reverse long-fought-for legislation, just because they are power-tripping. This is cherry-picking judges, many who are not qualified. ... I think I know right from wrong, more than some of these judges do.

It’s about saving lives and improving the quality of life for all of us.

+1000

 

[youbet]

MichaelB....... Have you ever seen a listing of what insurance companies allow as charges for any of the above? For example, my GP always takes my BP and yells at me about my boozing and flab no matter why I'm there. I'm wondering, because doing those things are listed in your post above, if he's getting some payment for including them even though I'm there because my knee is swollen.

I'd sure hate to see the immunizations go uncovered.

Do you think insurance companies might go to a fall back position of continuing to offer these preventative services but with a small, generally affordable co-pay as opposed to not covering them at all?

 

[Montecfo]

No. He did not strike down all preventative care requirements. Only those which came from a volunteer group which was not elected nor senate confirmed. it is not a blanket strike down of preventative care. There were three sources of recommendations, this was just one of them.

The idea that such appointments require Senate approval is in the Appointments clause of Article II of the Constitution.

And he did not make those illegal. They can still be offered.

Will be interesting to see how this moves forward in the appeals process.

 

[USGrant1962]

I don't believe this ruling has anything to do with immunizations. The relevant recommendations are the A and B list from PSTF. https://www.uspreventiveservicestas...ic_status=P&grades[]=A&grades[]=B&searchterm=

From the Bloomberg article above:

O’Connor’s decision doesn’t affect coverage recommendations made by the Health Resources and Services Administration and the Advisory Committee on Immunization Practices. These include contraceptive care and vaccine recommendations. Both those groups are subject to HHS oversight.

The issue is that PSTF has zero oversight and their recommendations automatically become law.

 

[Montecfo]

I do not think immunizations in general are in danger. The coverages in question are for services including mammograms and screenings for colon cancer, HIV, cervical cancer, and gestational diabetes, according to the published reports I have seen.

ETA: USGrant1962 provided better details above.