Obamacare’s requirement that health insurance cover free preventive care is at risk of being overturned after a federal judge in Texas ruled the Comprehensive Affordable Care Act unconstitutional.
U.S. District Judge Reed O’Connor’s decision was not entirely unexpected, but his decision to impose a nationwide ban still sent shock waves through the health care system. The protective services order is extremely popular and could end up affecting more than 100 million Americans.
Here are five things to know about the ruling.
Immediate effects are not clear
The ruling will take effect immediately, but it may not take effect immediately.
“I think this will happen over time,” said Larry Levitt, vice president of health policy at the Kaiser Family Foundation.
Health insurers price their plans annually and are required to notify consumers when there is a change in coverage. If the ruling is upheld, plans won’t change until the next calendar year.
The insurance industry’s main lobby group also tried to reassure people.
“We want to be clear: Americans need peace of mind that there will be no immediate disruptions in care or coverage,” said AHIP President and CEO Matt Eales.
Of course, there’s no law preventing insurance companies from changing their policies mid-year, experts say, and it’s a logistically complex decision—especially for a policy that can be overturned or changed on appeal.
O’Connor also vetoed ObamaCare’s mandate to cover HIV prevention drugs for free for at-risk adults, so some plans may drop coverage immediately.
Additional protective services may be jeopardized during an appeal.
The Justice Department formally appealed the decision on Friday, but the plaintiffs are appealing.
O’Connor opposed the preventive services mandate, but rejected arguments that would remove the law’s contraceptive coverage mandate and require insurers to cover other services, such as vaccinations.
Those can be set aside on appeal.
“No one is happy with this decision,” said Laurie Sobel, associate director of women’s health policy at the Kaiser Family Foundation. “The administration will appeal, the plaintiffs will appeal … so all defense services are up for grabs as we go through the appeals process.
The case now goes to the Fifth Circuit, one of the most conservative in the country.
It affects many defense services, but not all
One of the uncertainties about its impact is that the O’Connor decision only applies to preventive care recommendations after the Affordable Care Act was enacted in 2010.
He passed. These include stress testing for children, statins for cardiovascular disease, and high-risk breast cancer screenings.
Many recommendations, including mammograms and some cervical cancer screenings for women over 50, were taken before 2010. But over the years, these recommendations have evolved, so insurers work in an outdated landscape. .
O’Connor supported the mandate of two other Department of Health and Human Services agencies. One sets standards for how vaccines should be used, and the other recommends reproductive health services.
Under Obamacare, health insurers cannot require health insurers to pay anything out of pocket for preventive services services for those with an A or B rating from the US Preventive Services Task Force, a federal advisory committee. O’Connor said the task force is unconstitutional, as well as needing to cover any recommendations it makes after the ACA becomes law.
There is not much that states can do to protect workers.
“There are real limits to what states can do here,” KFF’s Levitt said. “So I think states can and will move to fill some of the gaps that this governor leaves, but there are still big gaps.”
States can regulate private insurance, but employer plans that cover most private insurance cannot be affected by state regulations, he said.
There are currently 15 states with laws requiring individual market insurers to cover the same preventive services required by the ACA, without cost sharing.
It gives the Democrats new political aspirations
Democratic congressional leaders quickly condemned the decision, even as it put Obamacare in a position accustomed to defending it from GOP attacks.
“Once again, a Republican activist judge based on the ideology of MAGA has issued a decision and not a law that will undercut our health care system and is opposed by many Americans,” said Senate Majority Leader Chuck Schumer (DN.Y.). In the statement.
Levitt said Congress could easily solve the problem with a simple one-line bill. But the politics of the ACA, even 13 years later, make it unlikely that anything will pass.
“It doesn’t take many words to fix this in law, but it may take some serious politics,” Levitt said.
Preserving Obamacare was a key part of Democrats’ messaging that helped them take control of the House in 2018, and Thursday’s decision puts the law front and center in 2024.
“This case is yet another attack on the Affordable Care Act — which has survived three challenges at the Supreme Court for 13 years as the law of the land,” White House press secretary Karin Jean-Pierre said in a statement Friday after the DOJ filed its appeal.
“Preventive care saves lives, saves families money, and protects and improves our health. Because of the ACA, millions of Americans have free cancer and heart disease screenings. This decision puts critical care at risk,” she said.
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