Court Ruling Regarding Free Preventive Care Expected Soon

Court Ruling Regarding Free Preventive Care Expected Soon

Within the next few months, a decision is expected to be made regarding the constitutionality of the Affordable Care Act’s (ACA) preventive care mandate. The ACA requires that non-grandfathered health plan and issuers cover preventive services. Preventive services include screening tests, immunizations, behavioral counseling, and medications that can prevent the development or worsening of diseases and health conditions. These services are to be provided without imposing cost-sharing requirements or deductibles.

 

In March 2023, the U.S. District Court for the Northern District of Texas repealed a significant component of the ACA’s preventive care mandate. It was ruled by the District Court that the following four preventive care coverage requirements were unconstitutional:

  • Services rated on an A or B rating by the U.S. Prevention Services Task Force (USPSTF);
  • Routine immunizations recommended by the Advisory Committee on Immunization Practices (ACIP);
  • Evidence-informed services for children recommended by the Health Resources and Service Administration (HRSA); and
  • Evidence-informed women’s health care recommended by HRSA.

 

The Biden administration appealed the decision to the 5th Circuit, with arguments heard on March 4, 2024. If it is ruled that the ACA’s preventive care mandate is unconstitutional, employers will want to consult with their Creative Benefits, Inc. team member to assess the impact on their health coverage. The impact may not be immediate, as midyear changes to plan coverage is unusual. For now, non-grandfathered health plans and issuers must continue to cover, without cost sharing, the full range of preventive care services required by the ACA. A ruling by the 5th Circuit is expected soon, likely followed by an appeal to the U.S. Supreme Court.

 

Creative Benefits, Inc. will release updates as more information is made available.