Obamacare preventive protection affected by most cancers, diabetes, HIV

A pharmacist writes a prescription in New York City.

Yvonne Hemsey | Hulton Archives | Getty Images

A federal judge on Thursday struck down an Obamacare mandate that requires most private health insurance plans to offer free screening services, which include everything from screening for certain types of cancer and diabetes to drugs used to prevent HIV.

The ruling by Judge Reed O’Connor of the US Northern District Court of Texas applies to medications, screenings and other forms of health care recommended by an independent panel of experts called the Preventive Services Task Force.

Under the Affordable Care Act, private health plans were required to cover mammograms for breast cancer in women ages 50 to 74, as well as screening for colon, cervical, and lung cancer.

The mandate also included drugs that prevent HIV infection in high-risk groups, called pre-exposure prophylaxis, or PrEP. Most private plans also had to cover screening for certain sexually transmitted infections, such as chlamydia and gonorrhea.

Obamacare requirements included screening for type 2 diabetes, among many other forms of health care.

Lawrence Gostin, a leading health law expert, said full coverage of these essential services with no out-of-pocket expenses is now in jeopardy.

“The overall picture is crystal clear. Virtually everything Americans rely on to keep themselves and their families healthy and prevent disease will no longer be required under the Affordable Care Act,” said Gostin, a professor at the Georgetown University Law Center.

Here’s a full list of precautionary measures that the judge’s ruling is likely to apply to

O’Connor’s ruling said that coverage requests based on recommendations from the Preventive Services Task Force were unlawful because the panel’s members were not nominated by the President and confirmed by the Senate. Therefore, the federal government cannot enforce a supply mandate on the basis of these recommendations, he said.

The Biden administration is likely to appeal the verdict. The US Department of Health and Human Services, which oversees Obamacare regulations, did not immediately respond to a request for comment.

Gostin said most private insurance plans will likely continue to cover these preventative health services, but will charge deductibles and co-payments.

“It’s going to hit working-class Americans first,” he said, noting that many people will miss out on basic health care because they can’t afford the out-of-pocket costs.

The judge’s ruling came after two Christian companies and several individuals sued the federal government in 2020. The lawsuit argues that the precautionary mandate violates their freedom of religion because it includes coverage for drugs to prevent HIV infection.

Plaintiffs allege in their lawsuit that the PrEP mandate “compels religious employers to insure drugs that facilitate and encourage homosexual behavior, prostitution, sexual promiscuity and injecting drug use.”

They also alleged that the Preventive Services Task Force’s recommendations were invalid because the process used to select the panel’s members violated the U.S. Constitution’s nomination clause.

O’Connor, in the same decision Thursday, dismissed an argument by plaintiffs to also overturn the mandate requiring Obamacare-compliant birth control coverage plans without out-of-pocket expenses.

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