Judge Nixes Preventive Services Coverage Mandate, but Fight Isn’t Over

A federal judge in Texas on March 30 struck down the Affordable Care Act’s requirement that health plans cover, without cost sharing, certain preventive services recommended by the U.S. Preventive Services Task Force (USPTF) — such as preexposure prophylaxis (PrEP) for HIV and screenings for HIV, cancers, suicide risk, and hepatitis C. Policy experts say insurers probably won’t rush to stop covering most affected services, but if the ruling is upheld, they could impose potentially burdensome cost-sharing on PrEP drugs in particular.

The ACA requires private health plans to cover preventive services recommended by several federal bodies without any cost to members. Those entities are the USPSTF, the Advisory Committee on Immunization Practices (ACIP) and the Health Resources and Services Administration (HRSA). In his ruling, Justice Reed O’Connor found that the policymaking power USPSTF wields would require the task force to be appointed by the president and confirmed by the Senate — but the USPSTF is appointed by federal civil servants, not the president. In O’Connor’s view, that means issuing plan requirements based on USPSTF recommendations is unconstitutional.

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Peter Johnson

Peter Johnson

Peter has worked as a journalist since 2011 and has covered health care since 2020. At AIS Health, Peter covers trends in finance, business and policy that affect the health insurance and pharma sectors. For Health Plan Weekly, he covers all aspects of the U.S. health insurance sector, including employer-sponsored insurance, Medicaid managed care, Medicare Advantage and the Affordable Care Act individual marketplaces. In Radar on Drug Benefits, Peter covers the operations of (and conflicts between) pharmacy benefit managers and pharmaceutical manufacturers, with a particular focus on pricing dynamics and market access. Before joining AIS Health, Peter covered transportation, public safety and local government for various outlets in Seattle, his hometown and current place of residence. He graduated with a B.A. from Colby College.

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