Appeals Court temporarily upholds ACA preventive services mandate

©Vitalii Vodolazskyi

The federal requirement for health plans to fully cover some preventive health services remains in place, at least for now.

On May 15 the U.S. Court of Appeals for the Fifth Circuit issued a temporary stay of a lower court ruling that the coverage mandate, which is part of the Affordable Care Act (ACA), was unconstitutional. The mandate applies to services such as diabetes, cancer, depression and HIV screenings that had been recommended for coverage by the United States Preventive Services Task Force (USPSTF). The services apply to people with health insurance coverage through employer-sponsored plans or coverage purchased through the ACA marketplaces.

The lower court decision was issued March 30 by Judge Reed O’Connor of the U.S. District Court for the Northern District of Texas. O’Connor ruled that insurance companies are not required to follow the mandate because the USPTF is not appointed Congress and thus lacks the constitutional authority to decide the services a health plan must cover. The U.S. Justice Department appealed the decision.

O’Connor, a Republican, was nominated to the court and approved by the Senate in 2007. In 2018 he ruled that the ACA was unconstitutional, a ruling that the Supreme Court later overturned. In 2022 O’Connor ruled that another provision of the ACA, which required employers to cover the HIV prevention pill PrEP, violated the plaintiff company’s religious freedom.

The stay remains in effect until the Fifth Circuit considers the Justice Department’s appeal. It’s widely believed that whichever side the court rules against will appeal to the Supreme Court.