Court Upholds ACA Preventive Care Compliance Amid Legal Proceedings

The US Court of Appeals for the Fifth Circuit determined that employers and health insurers must maintain compliance with Affordable Care Act (ACA) preventive care services provision while the law undergoes legal proceedings, the New York Times reported.

In March 2023, a district court judge ruled that the preventive care services provision overstepped employers’ religious rights by requiring them to cover preventive services such as PrEP and contraceptives. The remedy was that employers would not have to enforce all services with A or B recommendations from the US Preventive Services Task Force (USPSTF).

Under this ruling, efforts to enforce compliance with USPSTF A or B recommendations were considered illegal.

However, the US Department of Justice (DOJ) appealed this decision and, on May 15, the US Court of Appeals determined that enforcement of the lower court’s decision should be delayed until the ACA challenge is settled. Experts anticipate that the oral hearing for this case will occur during the summer of 2023.

Major healthcare organizations were vocal in their defense of the ACA preventive care provision. The American Medical Association submitted an amici curiae in December 2022, emphasizing the benefits of zero-cost preventive care on patients’ access to care and how it can define the patient journey.

After the US Court of Appeals’ decision, the American Heart Association, the American Cancer Society Cancer Action Network, and other organizations voiced their support.

“Numerous research studies have proven the benefits of preventive services. They ensure people can prevent, detect and treat their conditions as early as possible, improving health outcomes and saving patients and the health care system money,” healthcare leaders stated in the American Heart Association’s press release.

“This stay means that people in the U.S. can still access these lifesaving services at no cost as this case is appealed. Our organizations will continue to work to make sure everyone in the U.S. has access to quality and affordable health care.”