The Biden administration on June 12 finalized a tentative deal under the Affordable Care Act (ACA) that requires health insurers to cover preventative care like cancer screenings and HIV preventatives at no extra cost to patients while a legal challenge continues.
The agreement was first announced on Friday and is now finalized in a filing in the New Orleans-based 5th U.S. Circuit Court of Appeals. The deal keeps coverage intact nationwide, requiring a majority of health plans to continue providing preventive care at no charge while the case proceeds. In exchange, the administration agreed not to enforce the mandate to cover preventive care services against the small businesses challenging the provision. This means that even if the Affordable Care Act rules are upheld on appeal, the government can’t penalize the challengers for refusing to cover required services.
While the mandate is in place, it allows Texas-based Braidwood Management, one of a group of businesses and individuals that sued to challenge the mandate, to stop covering pre-exposure prophylaxis (PrEP) against HIV and other preventive services for its employees for now.
Braidwood and other plaintiffs sued the mandate specifically over PrEP for HIV, which they said violated their religious beliefs under the Religious Freedom Restoration Act (RFRA) by encouraging homosexuality and drug use.
The preventive care mandate, part of the Affordable Care Act (ACA), often referred to as Obamacare, covers services recommended by a federal task force. This mandate supports the nationwide efforts to end the HIV epidemic in the United States.
U.S. District Judge Reed O'Connor in Fort Worth, Texas, in March, blocked the federal government from enforcing the mandate for a much wider range of services, finding that the task force’s role under the ACA violates the U.S. Constitution.
However, the 5th Circuit temporarily blocked immediate enforcement of the ruling in May, bringing the health law’s provision back into effect. The appeals court also asked the two parties to come to a compromise on how much the mandate should be put on hold while it weighed its decision.
The 5th Circuit heard oral arguments on the case last week, and a ruling is expected in the coming months. An appeal to the U.S. Supreme Court is likely no matter which side prevails.
The ruling does not apply to services the task force recommended before the ACA was enacted in 2010, including breast cancer screening.
More than 150 million people were eligible for preventive care free of charge as of 2020 under the ACA, according to data from the U.S. Department of Health and Human Services.
