American Health Care Could be Upended by Court Ruling

The way the American health care system treats patients could be changed drastically depending on the outcome of a court case currently being heard by an appeals court in New Orleans, Louisiana.

On Monday, a panel of justices in the Fifth U.S. Circuit Court of Appeals is expected to hear arguments regarding an earlier ruling made by a judge in Fort Worth, Texas, in March 2023 that sought to block the federal government from mandating that insurers provide certain preventive services at no extra cost. The mandate is part of the 2010 Affordable Care Act, aka Obamacare.

The issue stems from a court case brought by Braidwood Management, a Texas-based health and wellness center operator, and other businesses in 2020 objecting specifically to the provision of coverage for pre-exposure prophylaxis (PrEP), a drug that prevents infections with HIV.

The plaintiffs argued that as they did not need PrEP, they should not be forced to pay for an insurance policy that included it, while Braidwood argued it would “facilitate or encourage homosexual behavior,” contrary to what it says are the Christian beliefs of the organization.

While HIV predominantly affects gay and ethnic minorities in the U.S, 22 percent of new infections in 2021 were through heterosexual intercourse and 8 percent were through drug misuse. Some 52 percent of infections in 2021 occurred in the South.

District Judge Reed O’Connor’s ruling in favor went further than the plaintiffs had called for, blocking the enforcement of the mandate for a range of services. It found that the U.S. Preventive Services Task Force, a body of medical professionals that recommends preventive services, did not have authority to make mandatory recommendations as they were not appointed directly by the president and confirmed by the Senate, despite being given the power to do so under the Affordable Care Act.

The Department of Health and Human Services (HHS) contends that there are “numerous statutes that incorporate by reference independent recommendations without creating any requirement that the heads of the recommending bodies be appointed as officer of the United States.”

In its appeal, the federal government noted that the provisions have been in place for over a decade. Removing them would “cause confusion” for health care providers and patients, it argued, who would be “needlessly deprived of life-saving coverage.”

Much of O’Connor’s ruling was put on hold while the appeal is considered, but if it is upheld, it would mean a majority of Americans would face not having the preventive services—which those who cannot afford them might be inclined to do—or being charged for them by insurers.

In a court filing, a number of medical bodies, including the American Medical Association, wrote that “no-cost preventive care saves lives, saves money, improves health outcomes, and enables healthier lifestyles.”

They added: “Identifying and treating conditions before they worsen, or before they present at all, yields better outcomes for patients and saves money for the health system overall.”

Leslie Dach, chair of nonprofit Protect Our Care, stated on Friday that if the cost-free preventive services were rescinded, “more Americans will suffer because their cancers will be detected too late or they won’t receive the mental health or prenatal care they need.”

According to research by HHS, as of January 2022, over 150 million people with private insurance benefited from the coverage of preventive services without cost sharing, alongside 20 million adults on Medicaid and 61 million people through Medicare.

Among the provisions recommended by the U.S. Preventive Services Task Force are free screenings for several chronic conditions, including high blood pressure screenings, Hepatitis B and C checks and diabetes testing.

Screenings for several forms of cancer—including cervical, lung and skin cancer—are also hanging in the balance, as well as a number of provisions for free contraceptives and vaccinations.

In a joint statement, 11 American medical associations, including several related to cancer, said on Monday: “Protecting access to cost-free preventive care is critical as coverage of recommended preventive services has saved millions from cancer, HIV/AIDS, diabetes-related complications such as kidney disease, and other chronic illnesses.”

Research published in 2019 suggested that the preventive services had eliminated 43 percent of the coverage gap between different income groups and reduced disparities in coverage between ethnic groups by 23 percent.

HHS has said that vaccination uptake also increased since cost-free preventive services were implemented, and the cost of contraceptives had decreased.