ACA Preventive Mandate Stays in Place with an Exception

In a recent decision, the U.S. 5th Circuit Court of Appeals upheld a key provision of the Affordable Care Act (ACA) that mandates private insurance cover preventive services without cost to patients. However, the court also ruled that the plaintiffs are exempt from complying with this mandate, setting the stage for potential future challenges. The appellate panel emphasized that the task force responsible for determining which preventive services should be covered must receive congressional confirmation, raising questions about the authority of groups making recommendations on contraception and vaccines.

The case stemmed from a lawsuit by Texas-based Christian companies Braidwood Management and Kelley Orthodontics, arguing that the ACA’s requirement to cover preventive care such as contraception, HPV vaccines, and HIV prevention drugs violated their religious beliefs. Initially, a district court sided with the employers, prompting an appeal by the Biden administration.

While the 5th Circuit overturned the lower court’s nationwide nullification of the preventive services mandate, it acknowledged concerns over the constitutional authority of the U.S. Preventive Services Task Force (USPSTF) to issue binding recommendations. The court’s decision requires USPSTF members to undergo presidential nomination and Senate confirmation moving forward.

The ruling’s implications are significant for the approximately 164 million Americans receiving employer-based health insurance, as it preserves access to vital preventive care services. Despite this immediate relief, advocacy groups caution that the decision could pave the way for future legal challenges that may threaten broader access to these essential health benefits.