Judge strikes down Obamacare coverage of preventive care for cancer, diabetes, HIV and other conditions

A federal judge on Thursday struck down an Obamacare mandate that requires most private health insurance plans to provide free preventive care that includes everything from screenings for certain cancers and diabetes to HIV prevention drugs.

The ruling by Judge Reed O'Connor of the U.S. Northern District Court of Texas applies to medication, screenings and other forms of health care recommended by an independent panel of experts called the Preventive Services Task Force.

Under the Affordable Care Act, private health insurance plans were required to cover mammograms for breast cancer among women ages 50 to 74, as well as screenings for colon, cervical and lung cancer.

The mandate also covered drugs that prevent HIV infection in high-risk populations, called pre-exposure prophylaxis or PrEP. Most private plans were also required to cover screenings for certain sexually transmitted infections such as chlamydia and gonorrhea.

The Obamacare requirements also covered screenings for Type 2 diabetes, among numerous other forms of preventive health care.

O'Connor in the same ruling Thursday rejected an argument by the plaintiffs to also overturn the mandate that requires Obamacare-compliant plans to cover birth control with no out-of-pocket costs.

Some 150 million Americans had access to free preventive care under the Obamacare requirements, according to the Health and Human Services Department.

Lawrence Gostin, a leading health law expert, said full coverage of these essential services with no out-of-pocket costs is now in jeopardy.

"The big picture is crystal clear. Virtually everything Americans have come to rely on to keep themselves and their families healthy and to prevent disease is no longer going to be required under the Affordable Care Act," said Gostin, a professor at the Georgetown University Law Center.

The Biden administration is likely to appeal the ruling. Kamara Jones, a spokesperson for Health and Human Services, said the agency is consulting with the Justice Department on next steps in the litigation.

"Preventive care is an essential part of health care: it saves lives, saves families money, and improves our nation's health," Jones said. "Actions that strip away this decade-old protection are backwards and wrong."

Senate Majority Leader Chuck Schumer, D-N.Y., called on the Biden administration to appeal the ruling immediately. He also called on insurers to publicly commit to providing free preventive care.

"This ruling is not only misguided, it is outright dangerous and could cost lives," Schumer said.

Gostin said most private insurance plans will probably continue to cover these preventive health-care services but charge deductibles and copays.

"It will primarily affect working-class Americans," he said, noting that many people will forgo essential health care because they can't afford the out-of-pocket costs.

O'Connor's ruling said that coverage requirements based on recommendations from the Preventive Services Task Force are unlawful because members of the panel were not nominated by the president and confirmed by the Senate. Therefore, the federal government cannot enforce a coverage mandate based on those recommendations, he said.

The Preventive Services Task Force is made up of 16 volunteers who are doctors, nurses, public health experts and other medical professionals. They are appointed by the director of a federal organization called the Agency for Healthcare Research and Quality.

The judge's ruling came after two Christian businesses and several individuals sued the federal government in 2020. That lawsuit argues that the preventive care mandate violates their religious freedom because it includes coverage of the drugs that prevent HIV infection.

The plaintiffs claim in their suit the PrEP mandate "forces religious employers to provide coverage for drugs that facilitate and encourage homosexual behavior, prostitution, sexual promiscuity, and intravenous drug use."

They also claimed the Preventive Services Task Force's recommendations are invalid because the process used to select the body's members violates the U.S. Constitution's Appointments Clause.