Federal Judge Strikes Down ACA's Preventive Care Mandate

Author: David B. Weisenfeld, XpertHR Legal Editor

April 10, 2023

A key provision of the Affordable Care Act (ACA) mandating free coverage for preventive health care services has been struck down by a federal judge in Texas. The recent ruling applies nationwide and could jeopardize access to care for millions of Americans if it is upheld.

Some of the services potentially affected include screenings for:

  • Cancer;
  • Diabetes;
  • Heart disease;
  • HIV;
  • Depression; and
  • Vision tests for children.

Some insurers have said they plan to continue offering the services at no cost, and others may wait to see the outcome of various appeals before changing course.

The Biden administration has already filed an appeal to the ruling. "This decision threatens to jeopardize critical care," said White House Press Secretary Karine Jean-Pierre in calling it "yet another attack on the Affordable Care Act."

The plaintiffs in this case took aim at HIV treatments in particular, claiming the ACA preventive care mandate violates the Religious Freedom Restoration Act by requiring employers to subsidize treatments for HIV drugs and treatments.

In siding with the challengers on that claim, US District Judge Reed O'Connor wrote, "The ACA forces these plaintiffs to choose between purchasing health insurance that violates their religious beliefs and foregoing conventional health insurance altogether."

Judge O'Connor rejected separate arguments that tried to invalidate the ACA's contraceptive coverage mandate, so coverage for contraceptives remains unaffected by the ruling.

The ACA has survived three challenges in the Supreme Court during its 13-year existence. In the most recent challenge in 2021, the justices refused to strike down the ACA based on its minimum essential coverage provision (known as the individual mandate).