Federal Court Limits ACA Mandated Coverage for Preventative Care

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The future of the Patient Protection and Affordable Act’s (ACA) preventative care coverage requirements could be in jeopardy after a federal judge ruled that certain provisions of the mandate were unconstitutional.  Section 2713 of the ACA requires most health insurers, including ERISA-regulated group health plans, to cover a variety of preventive services without cost sharing, like copays, coinsurances, or deductibles.

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 burdened the employer’s freedom of religion, which, as plaintiffs argued, “would make [them]complicit in behaviors that violate [their]religious beliefs.”

Without preventative care coverage individuals are at risk for developing avoidable conditions, or stopping preventative treatments due to costs. Researchers at Georgetown University are calling on states to adopt coverage mandates to mirror the ACA’s requirements. While states do not have authority to regulate ERISA plans, they can require individual, small group and fully-insured large group plans to cover, without cost sharing, the same categories of preventive care services that are required by the ACA. Currently, at least fifteen states have broad preventive coverage mandates. Adopting these provisions will safeguard continued access to preventive care if the ACA’s preventive service mandate is struck-down more broadly. 

Read more about Georgetown University recommendations here.  Aimed Alliance’s full summary of the Federal District Court case here. 

Last Updated on December 30, 2022 by Aimed Alliance

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