Braidwood Management v. Becerra
Brief Summary: A Federal District Court in Texas struck down the Patient Protection and Affordable Care Act’s (ACA) preventative services coverage requirement relying on both religious and constitutional grounds to permit employers to limit coverage for these services
Background: The ACA requires health plans to cover a variety of preventive services without cost sharing, such as copays, coinsurances, or deductibles. The preventive services mandate applies to all private plans, including individual, small and large group, and self-insured plans.
The list of preventative services covered under this mandate are created by three entities: (1) the Preventative Services Task Force which scores evidence-based services and requires all services receiving an “A” or “B” score to be covered with no cost-sharing; (2) the Advisory Committee on Immunization Practices (“ACIP”) which recommends vaccines for children and adults; and (3) the Health Resources and Services Administration (HRSA) which develops preventative care guidelines for women and children.
The claims alleged by Braidwood Management are brought under three provisions of the U.S. Constitution: the Appointments Clause, the Vesting Clause, and the non-delegation doctrine. The Appointments Clause empowers the President to appoint “principal officers” with the advice and consent of the Senate. The Vesting Clause vests executive power to the President, who must “take care that the laws be faithfully executed.” The nondelegation doctrine is a principle dictating that Congress cannot delegate its legislative powers to other entities. Claims were also brought under the Religious Freedom of Restoration Act (RFRA), which prohibits the government from substantially burdening a person’s exercise of religion.
Overview: The plaintiffs are individuals and businesses that sued the Department of Health and Human Services, the Department of the Treasury, and the Department of Labor because they wanted to exclude services currently required by the preventative care mandate from the health plan coverage they offered. The plaintiffs made three claims regarding the preventive services mandate. First, the plaintiffs argued that the preventative services mandate violates the Appointments Clause because members of the Preventative Service Task Force were unconstitutionally elected without presidential appointment and Senate confirmation.
Second, they argued that the preventative services mandate violated the Vesting Clause because members of the Preventative Services Task Force were unconstitutionally exercising executive presidential power to determine which services are included in the preventative services mandate.
Third, plaintiffs argued that the preventative services mandate violated the nondelegation doctrine, because the Preventative Services Task Force, ACIP, and HRSA, were all unconstitutionally exercising decision-making authority delegated to Congress when they determined which services should be included under the preventative services mandate.
Lastly, plaintiffs alleged that being required to cover an HIV prevention medication known as preexposure prophylaxis (PrEP), violated the Religious Freedom Restoration Act because it substantially burdened the exercise of their religious beliefs because it “facilitate[d]and encourage[d]homosexual behavior, prostitution, sexual promiscuity, and intravenous drug use.”
On September 7, 2022, Judge Reed O’Connor, a federal district court judge in the Northern District of Texas, held that the ACA’s PrEP preventive care coverage mandate was unconstitutional because it violated the Religious Freedom Restoration Act. The court reasoned that providing this coverage would substantially burden the employer’s freedom of religion, which, as plaintiffs argued, “would make [them]complicit in behaviors that violate [their]religious beliefs.”
On January 30, 2023, the DOJ and the plaintiffs finished briefing on the scope of a relief for the Court’s ruling on the fate of the ACA’s preventative services coverage requirement. Read the plaintiff’s motion here. Read the DOJ’s motion here.
On March 30, 2023, Judge Reed O’Connor, a federal district court judge in the Northern District of Texas, issued a broad decision vacating the implementation and enforcement of certain ACA-required preventive services provisions. The court held that all agency action taken to implement or enforce the mandated coverage of U.S. Preventive Services Task Force, “A” or “B” recommended services was unlawful. The court reasoned that the mandated coverage violated the Appointments Clause of the U.S. Constitution. The court also held that the PrEP mandate violated the plaintiffs’ rights under RFRA and enjoined the Defendants from enforcing the mandate against the plaintiffs.
On March 31, 2023, the federal government filed an appeal with the United States Court of Appeals for the Fifth Circuit (Fifth Circuit), requesting the court review the district court’s decision. While the Fifth Circuit reviews the appeal, the federal government filed a motion to stay with the district court while the Fifth Circuit reviewed the appeal. The district court indicated it needed additional information before ruling on the request for a stay. On April 27, the federal government elevated its request for a motion to stay, to the Fifth Circuit.
Court Updates: On June 21, 2024, the Fifth Circuit Court of Appeals upheld the district court decision, ruling that the ACA’s mandate requiring health plans to cover USPSTF-recommended services without cost-sharing is unconstitutional.
The Court reasoned that Task Force members are principal officers of the United States because they have the ability to have the “final word” on what services and items must be covered under the ACA’s preventative care requirements with no oversight authority to reject their final decision. Read the opinion here.
However, they found that the district court erred in granting nationwide relief to block enforcement of the ACA’s preventive services provision because the parties brought their claims under a constitutional theory rather than an Administrative Procedures Act claim. Therefore, the Court limited the relief just to the named plaintiffs in the lawsuit.
Current Status: The case will now go back to the district court to consider whether the other two administrative bodies behind the preventive-care mandates, ACIP and HRSA, violate the Appointments Clause. This Fifth Circuit did not make a decision on this issue because it was only raised on appeal and not addressed by the district court.
Impact: The preventative services coverage requirement ensures over 167 million Americans receive preventive services without cost-sharing through their private health plans. Limiting the scope of the decision is an important win for consumers and protects access to these services.
Last Updated on July 5, 2024 by Aimed Alliance
