ACA no-cost preventive health care mandate is restored, for now

Health insurance plans nationwide must continue to pay in full for all types of preventive care services, like certain cancer screenings and HIV prevention drugs, for the time being, due to an agreement reached by both sides in a lawsuit challenging the Affordable Care Act’s preventive services mandate. This new order leaves the mandate in place while the administration appeals a court order striking it down.

On Tuesday, the 5th U.S. Circuit Court of Appeals in New Orleans signed an order partially halting a Texas federal judge’s decision in the Braidwood Management v. Becerra case.  In March, the Texas judge had set aside recommendations made by one of three boards charged with deciding which health care services must be fully covered, leaving plans free to deny payment for those services.

This new order allows the US Health and Human Services Department to continue enforcing the requirement against all but the named plaintiffs in the Braidwood case. In exchange, the agency agreed not to seek penalties against these plaintiffs for any actions they’ve take on the basis of O’Connor’s order while it remains in effect, even if it’s later reversed.

Last week, the appeals court heard oral arguments over a Biden administration request that it pause the earlier decision during a lengthy appeals process. The ruling from U.S. District Judge Reed O’Connor had been on hold under an administrative stay while the appeals court considered whether it should be frozen long-term while the appeal of the case plays out.

Related: Outcome of Braidwood v. Becerra appeal will affect out-of-pocket costs for millions of consumers

The lawyer for the businesses and individuals challenging the ACA mandate argued that the administration is overplaying the harms that would occur if Judge Reed O’Connor’s ruling in the U.S. District Court for the Northern District of Texas case is not frozen for the appeal. It is not clear that insurers would drop the no-cost coverage of the services in response to O’Connor’s ruling, said Attorney Jonathan Mitchell.

However, lawyers for the Biden administration stressed that they are not seeking to block enforcement protecting the plaintiffs in the case from requirements to provide preventive care, but they do want a stay that would keep the Texas judge’s ruling from applying nationwide while the appeals play out.

Last Wednesday, federal appeals court judges told attorneys on both sides in the ACA preventive services case that they needed to reach a compromise, which has resulted in this current deal between the Biden administration and the plaintiffs in the Braidwood case.