Latest challenge to ACA’s preventive care provision could impact millions of privately insured

More than 2,000 legal challenges have been filed in state and federal courts contesting parts for all of the Affordable Care Act (ACA) since its enactment in 2010. The latest case, Braidwood Management v. Becerra, involves the ACAs’ requirement that most private insurance plans cover specific preventive care items and services — such as contraceptive care and supplies, as well as cancer screenings. The case could have long-term implications for millions of people who are covered by private insurance, according to a new brief from the nonprofit, Kaiser Family Foundation (KFF)

In Braidwood Management v. Becerra, two Christian-owned businesses and six individuals in Texas have challenged the legality of the preventive care mandates on constitutional grounds. The plaintiffs are also challenging the requirement to cover medication to prevent HIV, based on religious grounds.

In September, Judge Reed O’Connor at the U.S. District Court in the Northern District of Texas ruled partly in favor of the plaintiffs and partly in favor of the Department of Health and Human Services (which is defending the ACA). As KFF notes, the court did not issue an injunction blocking the enforcement of any of the preventive services requirements, but instead asked the parties for additional briefs on the scope of the remedy before deciding. Thus, the preventive services coverage policy remains in effect, but changes may be forthcoming because litigation is ongoing.

According to KFF, “if the plaintiffs succeed on either constitutional or religious claims, the government may no longer be able to require insurance plans to cover certain preventive services and items at no cost to patients. Insurers and employers would once again have discretion over whether to cover preventive services, resulting in lower premiums in some cases but also a patchwork of coverage. Any rollback of the government’s ability to enforce these requirements could impact the millions of people covered by private insurance. The outcome of this case could also have broader ramifications for the authority of federal agencies to address a wide range of issues through regulation.”

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The brief explains the preventive services coverage requirements, the basis of the lawsuit, next steps in the litigation, and the potential implications before concluding that “overturning the preventive services requirement broadly would have significant implications for coverage of a broad range of clinical preventive services. Should the final decision for this case be found in favor of the plaintiffs, and applied nationwide, then millions of people may be vulnerable to loss of guaranteed coverage of preventive services without cost sharing… This could widen access barriers for groups that already face increased barriers due to cost, including low-income people and people of color.”

Final briefs in this case are expected to be submitted in January, and KFF officials maintain that Braidwood Management v. Becerra has the potential to reach the U.S. Supreme Court.