The Obamacare mandate for preventive care is reinstated for the time being
Lawyers reached an agreement on Monday to preserve the mandate of the Affordable Care Act, requiring health plans to cover preventive care at no cost to patients.
A Texas district court ruled in March that part of the demand was unconstitutional. The decision took effect immediately, meaning insurers would no longer have to cover certain forms of preventive care, including a pill to prevent the spread of HIV
The Fifth Circuit Court of Appeals temporarily stayed the ruling last month, putting the provision of the health law back in effect. The appeals court also asked the two sides — a group of Texas residents and businesses challenging the law, and the Biden administration, which is defending it — to come to a compromise on how much of the mandate should be suspended while it makes its trade-offs. makes. decision.
The deal they reached leaves the provision almost entirely intact, requiring the vast majority of health plans to continue to offer free preventive care. The agreement includes an exemption for the small businesses and individuals challenging the provision; these entities are allowed to use a plan that does not cover all preventive services if they can find a health insurance company that offers it.
The appeals court, which is expected to rule later this year on the constitutionality of the preventive care mandate, has yet to approve the attorney’s agreement.
Health policy experts describe the mandate as one of the most transformative policies of the health law, known as Obamacare, because it can prevent worsening of disease and higher costs later on. It is also popular, with 62 percent of the public recently said it was “very important” that it stay in place.
Before the passing of the Affordable Care Act, in March 2010, patients sometimes faced high bills for preventive care, such as birth control or colonoscopies. Since the mandate came into force, studies have shown, more Americans have received blood pressure tests, cholesterol tests and flu vaccines.
In March, Judge Reed O’Connor of the Federal District Court for the Northern District of Texas ruled that part of the mandate was unconstitutional because an independent panel advising the government on the benefits to be covered lacked proper authority to do so.
Judge O’Connor’s ruling did not reverse the entire mandate for preventive services, but said it did not cover services that the panel, the United States Preventive Service Task Force, had recommended since 2010.
The newer services include three types of screenings: one for childhood anxiety, another for unhealthy drug use, and a third for weight gain in pregnant women. The mandate also included a recommendation that people at high risk of HIV take PrEP, a daily pill that is highly effective in preventing transmission of the virus.
The challengers in this case objected to treating PrEP in particular, claiming the drug “could encourage homosexual behavior or intravenous drug use.”
The deal may not have much practical impact for most Americans. When the court’s first ruling came in March, many health plans announced they would not change their benefits.
Health insurance companies typically have full-year policies, and it’s uncommon for them to change their members’ benefits in the middle of a contract. And insurers may be reluctant to take away a popular perk that in some cases saves them money by preventing serious illness later on.
Matt Eyles, the president of AHIP, the trade group that represents health insurers, said in a statement shortly after the initial ruling that there would be “no immediate disruption to care or coverage.”
The Blue Cross Blue Shield Association, which has health plans across the country, said in March it “would strongly encourage their members to continue to have access to these services to promote their continued well-being.”