Texas court blocks preventative care coverage for HIV, reproductive health

Originally written by Susan Morse and published by Healthcare Finance News on 3/31/23.

Providers and payers are speaking out against a Texas court decision yesterday that blocks preventative care coverage, including for HIV, cancer, and a range of reproductive health interventions, mandated in the Affordable Care Act. 

The decision in Braidwood v. Becerra in the U.S. District Court for the Northern District of Texas applies nationwide and takes effect immediately. Most health insurance plans are no longer required to cover many  preventive health care services at no cost to the consumer.

AHIP President and CEO Matt Eyles said, “We fully expect that this matter will continue on appeal, and we await the federal government’s next steps in the litigation, as well as any guidance from relevant federal agencies.” 

“Every American deserves access to high-quality affordable coverage and health care, including affordable access to preventive care and services that help avoid illnesses and other health problems.  As we review the decision and its potential impact with regard to the preventive services recommended by the United States Preventive Services Task Force, we want to be clear:  Americans should have peace of mind there will be no immediate disruption in care or coverage,” Eyles said. 

Dr. Jamila Perritt, ob/gyn and abortion provider in Washington, D.C. and president and CEO of Physicians for Reproductive Health said, “As a physician, I am appalled at today’s decision. An employer’s religious beliefs should have no place determining whether or not someone can access the personal and private healthcare they need whether that’s PrEP (pre-exposure prophylaxis), contraception, abortion, or other essential healthcare services. Access to PrEP medications and HIV treatment are essential, lifesaving components of reproductive healthcare.”

The Center for Health Law & Policy Innovation of Harvard Law School said the court’s ruling may be stayed pending appeal, which would prevent the ruling from taking effect until any appeals are resolved. 

Liz Kaplan, director of Health Care Access for the Center for Health Law & Policy Innovation, said, “Today’s decision from a single federal trial court in Texas threatens access to life-saving preventive care for more than one hundred million people, including many at risk of serious chronic health conditions. By preventing the government from ensuring affordable access to preventive services that are effective, up-to-date, and evidence-based, the court has needlessly undermined a critical aspect of the ACA.”

“The law the court has cast aside helps protect people from life-threatening conditions like HIV, hepatitis C, and lung and other cancers. It also reduces barriers to accessing preventive services that are an important tool in combating health disparities among people with lower income, People of Color, and the LGBTQ+ community. The court’s decision undermines efforts to reduce these disparities and improve health equity, and reinforces harmful, stigmatizing messages that impede the fight to end HIV.” 

WHY THIS MATTERS

The ACA required that most private insurance plans cover recommended preventive care services without cost sharing. 

But Christian owned businesses and six individuals in Texas asserted in the lawsuit that the requirements in the law were unconstitutional. The requirement to cover preexposure prophylaxis (PrEP), medication for HIV prevention, violates their religious rights, the plaintiffs said.

The ruling by Judge Reed O’Connor, who previously struck down the entire ACA before it was upheld by the Supreme Court, means the federal government’s ability to require insurance plans to cover preventive services without cost-sharing may be limited.

THE LARGER TREND

The court has struck down all federal actions since the ACA was signed into law that implements the mandate that most health insurance plans cover all services with a U.S. Preventive Services Task Force recommendation of A or B, including HIV preventive medications, Hepatitis C screening and certain cancer screenings and preventive treatments. 

In September 2022, the Texas court ruled partly in favor of the plaintiffs and partly in favor of the Department of Health and Human Services in the case.