Health Plans Must Continue Covering Preventive Care Services

A federal appeals court approved an agreement between parties in Braidwood Management v Becerra, preserving the mandate requiring health plans to cover preventive care services based on recommendations from the US Preventive Services Task Force (USPSTF).

In the initial lawsuit, the plaintiffs, including Texas-based Braidwood Management, Inc., argued that the preventive care mandate compromised the Constitution and the Religious Freedom Restoration Act (RFRA). The plaintiffs stated they should not have to cover HIV prevention medication as the “behaviors that make this preventive treatment necessary” violate their religious freedom.

In March, a US district judge sided with the plaintiffs and ruled that employers and health plans do not have to cover preventive care services recommended by USPSTF. US District Judge Reed O’Connor determined that the mandate was unconstitutional and ruled to invalidate the USPSTF as its members were not properly appointed.

The Biden Administration stated that the judge’s nationwide injunction should have only applied to the plaintiffs.

Under the recent joint stipulation approved by the Fifth Circuit Court of Appeals, health plans must continue to cover preventive care services, including contraceptives and PrEP medications, but the mandate will not apply to the plaintiffs.

While the federal government works to appeal Judge O’Connor’s ruling, it cannot penalize Braidwood Management for refusing to cover USPSTF-recommended preventive care services. Additionally, if the court upholds the mandate in the appeal, the Biden administration cannot retroactively penalize the plaintiff.

The agreement will maintain access to key preventive care services for millions of Americans. The Affordable Care Act (ACA) mandate requires health plans and employers to cover cancer screenings, preventive medications for chronic conditions, mental health screenings, and prenatal services without cost-sharing.

Data from Peterson-KFF found that 60 percent of privately insured Americans utilized preventive care services mandated by the ACA in 2018. The most common services received were vaccinations, wellness visits, and screenings for heart disease, diabetes, cervical cancer, and breast cancer.