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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