Federal judge removes Obamacare requirement for free screening

WASHINGTON — A federal judge in Texas, who once ruled the Affordable Care Act unconstitutional, issued a sweeping ruling Thursday barring the Biden administration from enforcing a provision of the law that provides patients with certain types of free care, including cancer screening, depression , diabetes and HIV

Judge Reed O’Connor’s decision of the Federal District Court for the Northern District of Texas applies statewide. If it continues, it could have far-reaching consequences for millions of Americans and take the United States back to the days before the 2010 health care law known as Obamacare, when insurers were free to choose what coverage they would provide.

The ruling, which is in the form of a statewide injunction, takes effect immediately, said Lawrence O. Gostin, a health policy expert at Georgetown University who has been following the case. It will affect a long list of screening services, he said, including services such as heart disease screening, Pap smears and tobacco cessation services.

“It could be that a woman wakes up tomorrow and finds her mammogram isn’t covered,” Mr Gostin said, adding: “I think we forget how it was before the Affordable Care Act where we had to pay and it was unaffordable for basic health care.”

But insurers and employers stressed that the decision would have no immediate impact on people’s coverage. “We want to be clear: Americans should have peace of mind that there will be no immediate disruption to supply or insurance coverage,” Matt Eyles, president and chief executive officer of AHIP, a large insurer trade group, said in a statement.

However, changes may occur over time. Any significant change would require advance notice, and employers and insurers would most likely wait until the next plan year to adjust the benefits they provide if they do so, the benefits experts said.

The Biden administration will almost certainly appeal the verdict and request a stay of the injunction. White House press secretary Karine Jean-Pierre said the Justice Department and Department of Health and Human Services would review the decision.

The fight against HIV

An estimated 40 million people are living with HIV worldwide. About 10 million of them do not have access to treatment.

• A life-saving program: In the 20 years since its inception, the President’s Contingency Plan for AIDS Relief has brought HIV treatment to more than 20 million people in 54 countries, according to a new report.
• Injectable PrEP: An injection every two months instead of a daily pill could protect many more women from HIV, but the vaccine is not available where it is needed most.
• The search for a vaccine: Janssen Pharmaceuticals ended a worldwide study after experts found the vaccine was not effective. But there are other options in the pipeline.
• left behind: Sub-Saharan Africa has made steady strides in providing life-saving medicines to adults. But young patients are harder to reach.

“This case is another attack on the Affordable Care Act,” Ms Jean-Pierre said, adding, “Preventive care saves lives, saves families money and protects and improves our health.”

The lead plaintiff in this case is Braidwood Management; The company’s owner, Dr. Steven F. Hotze, is a prominent Houston Republican donor and physician who previously challenged the Affordable Care Act. The plaintiffs argued that a volunteer panel of experts that makes binding recommendations on what statutory benefits should be covered by the law is unconstitutional because its members are not appointed by the President or confirmed by the Senate.

The plaintiffs also highlighted drugs that prevent HIV/AIDS, arguing that the requirement to cover those drugs violates the Restoration of Religious Freedom Act, a 1993 law that prevents the government from encumbering a person’s religious freedom .

“This decision brings uncertainty to an aspect of the health care system that has benefited people for nearly a decade: access to no-cost screening,” Natalie Davis, executive director of United States of Care, a nonpartisan health advocacy group, said in a statement.

Ms Davis said the ruling means nearly half of Americans — more than 151 million people — “could lose access to free preventive services like mental health, weight-loss interventions and various cancer screenings that we all rely on.”

Advocates for people living with HIV/AIDS were particularly alarmed by the decision.

“The fact that a judge in Texas decided to threaten the health care of all Americans because of ideological fringe views should really terrify every American,” said James Krellenstein, a longtime HIV/AIDS activist.

Judge O’Connor’s verdict came as no surprise. In September, he ruled that the US Preventive Services Task Force — a volunteer panel of experts that recommends what types of preventive care should fall under the Affordable Care Act — violated the Constitution. Thursday’s decision follows from that earlier decision.

The September ruling also specifically targeted the HIV drug treatment known as pre-exposure prophylaxis, or PrEP, and said the legal requirement that it be covered violates Braidwood Management’s freedom of religion. A recent analysis by researchers at Yale and Harvard estimated that for every 10 percent decrease in PrEP coverage among men who have sex with men, there would be an additional 1,140 HIV infections in that population in the following year.

Thursday’s ruling comes just a week after the 13th anniversary of President Barack Obama’s signing of the Affordable Care Act. In 2012, the Supreme Court upheld most of the law but overturned its requirement that states expand Medicaid. In 2018, Judge O’Connor ruled that the entire statute was unconstitutional, but the Supreme Court later overruled it.

Some experts said mandatory preventive benefits are now so ingrained in America’s healthcare system that it would be difficult for employers and insurers to remove them, and many would choose not to.

Even before the mandate went into effect, many employers offered such benefits to workers, said Beth Umland, director of research for health and benefits at Mercer, a consulting firm. The tight labor market and the value of these services make employers unlikely to want to discontinue coverage, she said.

“They are unable to reclaim popular low-cost benefits that employees have been accustomed to for years,” she said.

Some insurers said they plan to continue offering the services for free. Cigna Healthcare said its “intent is to continue to provide the full range of recommended preventive services at no cost to our customers as part of our standard coverage policy, regardless of the ultimate outcome of this litigation.”

But the lack of a mandate could eventually result in some employers or insurers slashing such coverage, particularly for more costly services. It would then “go to the races, and people will lose some important protections,” said Katherine Hempstead, a senior policy adviser at the Robert Wood Johnson Foundation, who has closely followed the Affordable Care Act.

Insurers can also await the outcome of various legal actions before changing course. “We expect this to drag on,” said John Baackes, chief executive officer of LA Care Health Plan, a California insurer. “I don’t think anyone will jump in to make changes until the fog clears.”