A federal judge in Texas struck down a key provision of the Affordable Care Act that could result in patients paying for certain preventative medical procedures that they currently receive for free.
Reed O’Connor, a Fort Worth judge who listed as someone who has participated with or spoken to the conservative Federalist Society, ruled Thursday that a requirement under the 2010 health care law that insurers fully cover some preventative care was unconstitutional.
That means insurance companies can start charging copays or impose deductibles for some cancer screenings and HIV medication that are currently free to patients.
Vanessa Wellbery, vice president of policy and advocacy for Planned Parenthood of St. Louis and Southwest Missouri, said Thursday that O'Connor's ruling was "going to make a bad situation worse."
Wellbery said imposing costs on patients for preventative care could impact access to medications for preventing HIV infections and services for pregnant woman as maternal mortality rates in the United States are increasing, particularly among Black women.
"States like Missouri will be continuing to dismantle the health-care safety net when that safety net is already at capacity," Wellbery said.
The ruling only applies to preventive care recommended by the U.S. Preventive Services Task Force after 2010, which means many of the most commonly used screenings — mammograms, for example, and some tests for sexually transmitted infections — will still be covered without a copay. However, if those guidelines have been updated since 2010, under the ruling, insurers could be required to comply with outdated rules.
O'Connor ruled in the same case in September that requiring coverage of the HIV prevention drug pre-exposure prophylaxis, or PrEP, violated the plaintiffs' religious beliefs — and that the U.S. Preventive Services Task Force is unconstitutional.
Lindsey Dawson, director of LGBTQ health policy and associate director of HIV policy at the Kaiser Family Foundation, said people on PrEP are disproportionately insured by the commercial insurance market, so they may have to pay for part or all of the medication if the ruling stands.
Those costs can add up, she said — generics run about $30 per month, while the brand-name drugs could run to more than $20,000 per year. Lab tests and other services related to PrEP would cost an estimated $2,000 per year out of pocket, she said.
O'Connor, an appointee of former President George W. Bush, has previously ruled against the ACA.
Larry Levitt, executive vice president for health policy for the Kaiser Family Foundation, said he expects most insurers will continue their current practice of not charging for preventative services at least through the end of the year.
“I think this will play out over time,” Levitt said.
The Biden administration is expected to appeal the decision.
But if O’Connor’s ruling ultimately stands, experts predict that patients will avoid preventative care if their insurance company expects a copay or a deductible.
“Cost sharing, even small amounts, really reduced the likelihood that people use preventive services,” said Alina Salganicoff, senior vice president and director of women’s health policy at KFF.
