https://www.kaufmanhall.com/insights/blog/gist-weekly-june-28-2024

Last Friday, the Court of Appeals for the Fifth Circuit in New Orleans overturned a district court ruling that had nullified a requirement in the Affordable Care Act (ACA) that private insurers cover certain preventive care services without patient cost-sharing, although a nationwide injunction had kept the mandate in place while the case was appealed.

In a decision that the judges themselves described as a “mixed bag,” the circuit court ruled that the US Preventive Services Task Force (USPSTF) lacked constitutional authority to issue legally binding recommendations, as its expert volunteer members are not nominated by the president and confirmed by the Senate.

However, only the plaintiffs—two companies in Texas that argued covering contraceptives, HPV vaccinations, and HIV prevention medicines violated their religious beliefs—have been granted relief to disregard USPSTF recommendations, and all other companies must remain in compliance. The circuit court also declined to rule on the legality of ACA coverage recommendations for contraceptives and vaccines, which are issued by other advisory groups than the USPSTF, instead returning these matters to the original district court.

The Gist: Although this decision leaves the door open for further rulings and legal challenges, providers and patients can celebrate that preventive care services remain free of cost-sharing, for now.

The preventive care mandate is one of the ACA’s most popular provisions, and overturning it would be highly disruptive and harmful to patient health, especially given about half of US adults say it’s difficult to afford healthcare costs.

This ruling also suggests that a permanent resolution to legal questions surrounding the USPSTF’s authority may require Congressional action.