Texas Federal Court Ends Enforcement Of ACA’s Preventative Care Requirements

CATEGORY: Client Update for Public Agencies
CLIENT TYPE: Public Employers
DATE: May 04, 2023

Six individuals and two businesses filed a lawsuit against the federal government challenging the legality of the Affordable Care Act’s (ACA) preventative care mandates.  The ACA requires private health insurance companies to cover preventative care services with no cost-sharing (meaning at no additional payment beyond the premium).

Each plaintiff objected to the preventative care mandate for religious or personal reasons or both.  Specifically, plaintiffs want the option to purchase health insurance that excludes preventative care coverage for pre-exposure prophylaxis (PrEP) drugs for HIV prevention, contraception, the HPV vaccine, and screenings and behavioral counseling for STDs and drug use.  They claimed they do not require such preventative care and that it violates their religious beliefs to provide such insurance coverage because it makes them “complicit in facilitating homosexual behavior, drug use, and sexual activity outside of marriage between one man and one woman.”

Previously at issue in this lawsuit was the ACA’s delegation to the U.S. Preventative Services Task Force (PSTF) to determine what types of preventative care services health plans must cover.  The U.S. District Court for the Northern District of Texas determined that the PSTF’s recommendations violated the Appointments Clause of the U.S. Constitution because the Task Force members were not appointed through a Presidential nomination with consent by the Senate.  Therefore, the Court ruled that any actions taken based on PSTF’s recommendations were vacated.

In the Court’s most recent ruling on March 30, 2023, it determined that the PrEP coverage mandate violates the Religious Freedom Restoration Act (RFRA).  The RFRA generally prohibits the government from substantially burdening an individual’s exercise of religion.  The Court determined that the PrEP coverage mandate substantially burdens the plaintiffs’ religious exercise due to their belief that purchasing PrEP drugs makes them complicit in behaviors condemned by the Bible.  The Court agreed with the plaintiff’s argument that the ACA forces them to choose between purchasing health insurance that violates their religious beliefs and foregoing conventional health insurance altogether.  The Court did not find that the federal government had a compelling government interest to require the coverage or that the PrEP coverage mandate was the least restrictive means of furthering the government’s interest.

As a result of the decisions, the Court declared any governmental action taken to implement or enforce PSTF’s recommendations for preventative care was unlawful.  Therefore, the plaintiffs were not required to obtain or provide coverage with preventative care services.  Since the Court found more specifically that the PrEP coverage mandate violates the RFRA, individuals, and employers are not required to obtain or provide PrEP coverage as a type of preventative care.

Should this decision be applied by other district courts, courts of appeal, or nationwide, the broader implication of this lawsuit is that preventative care coverage without cost-sharing will become an option and not a requirement.  Health insurance plans and employers will have the discretion to determine what preventative services, if any, will be covered and whether they will charge additional amounts for the coverage.

Braidwood Mgmt. Inc. v. Becerra, 2023 WL 2703229 (N.D. Tex. 2023).

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