On Thursday, a Texas federal judge struck down an important Affordable Care Act policy: the mandate that private health insurance companies cover preventive care services entirely at no cost to patients.
The ruling entered into force immediately and is confidential throughout the country. It affects dozens of potentially life-saving preventive health care services recommended by the federal government, including drugs that prevent HIV transmission and screening for adolescent depression.
Health policy experts call free preventive care one of Obamacare’s most transformative policies because it removed a financial barrier to needed care for tens of millions of Americans. It is also one of the most popular provisions of the law, with 62 percent of the public recently saying it is “very important” that the law remains in force.
The new court ruling has already brought the Affordable Care Act back into the political fray, with Democrats quickly vowing to protect the law. The Biden administration plans to appeal the ruling, setting up the possibility of another presidential election cycle with a potential Supreme Court challenge to Obamacare looming.
For now, though the ruling is widespread, most people are unlikely to see their health benefits change overnight. Here’s what consumers need to know about how the ruling could change health insurance in the United States.
What did the judge find?
The Affordable Care Act relies on three panels of healthcare experts to advise the government on preventive services that insurance companies should cover.
Judge Reed O’Connor of the Federal District Court for the Northern District of Texas ruled that one of those commissions, the United States Preventive Services Task Force, does not have the constitutional authority to dictate what benefits health insurance companies must cover.
Judge O’Connor ruled in 2018 that the entire Affordable Care Act was unconstitutional, but the Supreme Court later overturned that decision and upheld the law. In this new case, Justice O’Connor found that having a panel of outside experts determine which preventive services should be covered violated the Appointments Clause of the Constitution, which says that legally important decisions are to be made by people who are part of a chain of powers. to the federal government.
said Nicholas Bagley, a University of Michigan law professor who has followed the Texas case carefully.
Who is affected by the ruling?
The mandate for preventive services in the Affordable Care Act would likely affect all Americans with private health coverage, not just those who get insurance through the Obamacare marketplaces.
That’s roughly 150 million people, most of whom get their health benefits through their jobs. The ruling does not appear to affect people with public insurance such as Medicare or Medicaid.
What are the health benefits at stake?
The Texas ruling means that insurance companies no longer have to provide free coverage for any care recommended by the US Preventive Services Task Force since 2010.
In that time, the federal task force has approved at least four new types of preventive care. This includes three new types of screening: one for anxiety in children, another for unhealthy drug use, and a third for weight gain in pregnant women. It also includes a recommendation for PrEP, a daily pill that is highly effective in preventing HIV transmission
The task force has also updated much of its outdated guidance. For example, it has repeatedly updated its recommendations for heart disease to endorse the use of statins in certain adult populations. Under the Texas ruling, insurers will not have to follow the most recent guidelines and can instead provide free coverage for any recommendations made in 2009 or earlier.
The provision does not apply to all preventive care. Insurance companies are still required to cover all types of contraception, for example, and all recommended vaccinations (including the Covid-19 vaccine) at no cost to patients. They also still have to cover mammograms, Pap smears, and other common exams recommended by the task force before 2010, but they won’t have to follow any of its newer guidance about when these tests are appropriate.
Will health insurance plans change immediately?
Since the ruling goes into effect immediately and applies nationwide, health insurance companies can legally begin applying co-payments and deductibles to newer types of preventive health care. But health policy and insurance plan experts say they don’t expect many consumers to experience an immediate change in their benefits.
This is because health plans usually have full-year policies, and it’s not unusual for them to change member benefits in the middle of a contract, especially when a court case is still ongoing. Insurance companies may be reluctant to take the popular benefit right away which, in some cases, saves them money by preventing serious illnesses later on.
“There will be no immediate interruption in care or coverage,” Matt Ailes, president of AHIP, the trade group that represents health insurers, said in a statement Thursday.
The Biden administration plans to appeal the decision, according to a court filing filed Friday afternoon. Experts also expect the federal government to continue to stay the sentence while the appeals process begins, though the White House has not yet commented on when it will do so.
The stay will put the Texas court’s decision on hold and put the preventive care mandate back into effect until higher courts can hear the case.
If the Texas decision is held, Mr. Bagley said, the case would likely take years to make its way to the Supreme Court because the issue would be less urgent.
But if a stay is not issued, the case could move quickly and potentially reach the Supreme Court before the 2024 election.
“It could lead to some race to the Supreme Court,” he said.
In a briefing Thursday, the White House press secretary, Karen Jean-Pierre, said the Biden administration “will continue to fight to improve health care and make it more affordable for hard-working families, even in the face of attacks from vested interests.”
Democrats have recently found political success defending the Affordable Care Act, especially since Republican efforts to repeal the law failed in 2017. Obamacare has become steadily more popular, and this new lawsuit could make it an even more prominent issue in the 2024 presidential campaign.
Republicans have been mostly silent on the ruling, a sign that dismantling the Affordable Care Act may have become a lost cause for the party. Top Democrats in Congress have rushed to defend the Affordable Care Act. “The protections of the Affordable Care Act have been affirmed time and time again in the face of continued attacks,” Senator Patty Murray of Washington said in a statement Thursday, adding, “I am not new to this fight, and I have no intention of backing down now.”