The federal requirement that health plans fully cover certain preventive health services remains in place, at least for the moment.
On May 15, the U.S. Court of Appeals for the Fifth Circuit granted a temporary stay to a lower court ruling that the coverage mandate, part of the Affordable Care Act (ACA), was unconstitutional. The mandate applies to services such as diabetes, cancer, depression, and HIV screenings recommended for coverage by the United States Preventive Services Task Force (USPSTF). The Services apply to individuals with health insurance coverage through employer-sponsored plans or coverage purchased through the ACA Markets.
The lower court ruling was issued March 30 by Judge Reed O’Connor of the U.S. District Court for the Northern District of Texas. O’Connor ruled that insurance companies are not required to follow the mandate because the USPTF is not appointed by Congress and therefore does not have the constitutional authority to decide which services a plan health must cover. The US Department of Justice appealed this decision.
O’Connor, a Republican, was appointed to the court and approved by the Senate in 2007. In 2018, he ruled that the ACA was unconstitutional, a decision that the Supreme Court later overturned. In 2022, O’Connor ruled that another provision of the ACA, which required employers to cover the HIV prevention pill PrEP, violated the plaintiff company’s religious freedom.
The stay remains in effect until the Fifth Circuit considers the Justice Department’s appeal. It is widely believed that the party against whom the court rules will appeal to the Supreme Court.
