ACA-Mandated Free Preventive Care Is in Jeopardy, But Hasn’t Always Been Free Anyway

On March 30, 2023, Judge Reed O’Connor in the U.S. District Court in the Northern District of Texas issued a ruling in the case, Braidwood Management Inc. v. Becerra, striking down the Affordable Care Act’s coverage requirement for certain preventive services with zero cost sharing. O’Connor ruled that the federal government cannot require health plans to cover services recommended by the U.S. Preventive Services Task Force (USPSTF) on or after March 23, 2010 — such as preexposure prophylaxis for HIV and screenings for HIV, cancers, suicide risk and hepatitis C. The Biden administration has appealed this decision to the Fifth Circuit Court of Appeals.

Since the 2010 passage of the ACA, millions of enrollees have used preventive services. In 2018, six in 10 privately insured people received some preventive care that’s subject to the ACA’s no-cost coverage mandate, with women, children and elderly adults more likely to use such care, according to a study published by the Peterson-KFF Health System Tracker. Another analysis by HHS’s Office of the Assistant Secretary for Planning and Evaluation estimated that about 151.6 million people had access to preventive care without cost sharing in 2020.

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