Texas court decides insurance should not cover free HIV drugs and cancer prevention

A Texas federal court struck down a key provision of the Affordable Care Act, known as Obamacare, jeopardizing the free coverage of a wide range of preventive services, including mammograms, cancer screenings, colonoscopies and mental health screenings, for nearly 168 million people who receive health insurance from an employer and in the individual Obamacare market. The edition told in more detail Politico.

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District Court Judge Reid O'Connor, author of several previous rulings against Obamacare, sided with conservative employers and individuals in Texas who argued that the US Preventive Services Task Force, which established these requirements, has been operating unconstitutionally since 2010. The decision blocks enforcement of the law across the country.

O'Connor, appointed by President George W. Bush to the US District Court for the Northern District of Texas, ruled that the requirement to cover HIV prevention drugs violates the religious rights of employers and cannot be used against them.

O'Connor wrote that employers and individuals had the right to sue because "forced coverage of these services violates their religious beliefs and makes them complicit in facilitating homosexual behavior, drug use, and sexual relations outside of marriage."

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Judge O'Connor partially agreed but did not grant two other demands - one for reasons of religious rights and the other for reasons of secular costs - to block the ACA's mandate for contraception. The applicants said they plan to appeal the decision.

The decision also does not affect access to free vaccines, which are covered by another part of the law.

This decision comes four years after the same judge ruled the entire Obamacare program unconstitutional, and the decision was later overturned by the US Supreme Court. This is another move in the long-term struggle of conservatives to repeal the health care law signed by the 44th President Barack Obama.

The administration of incumbent US President Joe Biden, which is expected to appeal to the conservative US Court of Appeals for the 5th Circuit, has made several arguments in defense of a landmark health care reform bill that the judge rejected, including that the availability of PrEP and other preventative Sexual health services are key to combating the spread of HIV.

While he acknowledged that there is "a compelling government interest in curbing the spread of a potentially fatal infectious disease like HIV," O'Connor said the government does not need to force private insurance companies to cover drugs like PrEP to achieve its goal.

O'Connor rejected the Justice Department's argument that employers cannot prove that they have been harmed as a result of preventive care insurance payments and therefore do not have the right to sue.

The decision notes that when Biden administration lawyers asked employers how much more coverage for preventive services increased their premiums, "Plaintiffs responded that they could not quantify the increased costs but knew their premiums had become too expensive to afford."

O'Connor sided with the employers as early as September, but did not say whether his decision would only apply to people filing a lawsuit, to everyone in Texas or across the country, and requested an additional briefing. O'Connor eventually granted requests for a "one-stop" solution that could potentially upend the national insurance market.

While 15 states require insurance companies to cover these types of preventive services regardless of federal law, these rules do not apply to employer self-insurance plans, which cover most people with private insurance.

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Democratic leaders are calling on the administration to immediately appeal what they called the "reckless decision," warning that it "endangers lives if people are forced to forego routine screenings and treatments."

“I urge all health insurance companies to commit to continuing to cover all preventive services without cost sharing while this case is under litigation and until a final decision is made on the claim,” said Frank Pallone, member of the Energy and Trade Committee.

Health insurance experts say that while the decision is unlikely to have an immediate effect, patients may be deterred from seeking services for fear of being billed for treatment.

“Most insurance plans are valid until the end of the year, so the effects will not be felt immediately, but this is not universal,” warned Nicholas Bagley is a University of Michigan professor of research into the implementation of the Affordable Care Act.

The case could eventually go all the way to the Supreme Court, which has repeatedly upheld the Affordable Care Act but cut important parts of the law, including requirements for contraceptive coverage and the expansion of Medicaid.

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