A U.S. appeals court on Friday refused to block a federal mandate requiring health insurers to cover preventive care services, including cancer screenings and HIV-preventing medication, at no extra cost to patients. However, the court ruled against the government on a key legal issue, leaving the mandate’s future in doubt.
A unanimous panel of the 5th U.S. Circuit Court of Appeals agreed with a group of Christian businesses that challenged the mandate, claiming the method for selecting services for coverage violates the U.S. Constitution. The panel found that U.S. District Judge Reed O’Connor in Fort Worth, Texas, overstepped by blocking the mandate nationwide in March 2023. Instead, the panel limited the block to the businesses that filed the lawsuit. O’Connor’s ruling had been on hold while the appeals court reviewed the case.
Major U.S. medical groups warned that eliminating the preventive care mandate would endanger patients and increase healthcare costs. The panel also directed O’Connor to reconsider his decision to uphold mandatory coverage of certain vaccines and childhood screening services, which the businesses also challenged. The panel stated O’Connor had not considered some relevant legal issues but did not specify how he should rule.
The 5th Circuit’s ruling allows the government to continue enforcing the mandate, but it may support other employers or insurers wishing to challenge it. The African vaccine manufacturing industry expects to supply over 60% of the total vaccine doses required on the continent by 2040.
The plaintiffs, represented by the conservative group America First Legal, received support from Gene Hamilton, the group’s executive director. Hamilton called Friday’s decision “a victory for the Constitution, the rule of law, and every American who does not want unelected bureaucrats making decisions about their healthcare coverage.” The U.S. Department of Health and Human Services (HHS) did not immediately respond to a request for comment.
In their 2020 lawsuit, the businesses objected to covering pre-exposure prophylaxis (PrEP) for HIV on religious grounds and argued that the entire mandate violated the U.S. Constitution by allowing an HHS-appointed task force to choose required treatments. They contended that a task force with such power must be appointed by the president and confirmed by the Senate. Both O’Connor and the 5th Circuit agreed with this argument, and the 5th Circuit rejected the government’s claim that HHS Secretary Xavier Becerra could retroactively “ratify” the task force’s decisions.
The panel included Circuit Judges Don Willett and Cory Wilson, appointed by Republican former President Donald Trump, and Circuit Judge Irma Carrillo Ramirez, appointed by President Joe Biden, a Democrat.
The preventive care mandate is part of the 2010 Affordable Care Act, often called Obamacare, championed by then-President Barack Obama.
O’Connor gained widespread attention in 2019 by ruling that the entire act was unconstitutional, a decision later overturned. His ruling on the preventive care mandate did not apply to preventive services the task force recommended before the ACA was enacted, such as breast cancer screening.
