On March 30, 2023, the U.S. District Court for the Northern District of Texas vacated actions taken by HHS to implement provisions of the Affordable Care Act (ACA) that require health insurance plans to include coverage for certain preventive healthcare services. Judge Reed O’Connor issued the decision and enjoined HHS from enforcing the ACA requirements after previously finding that the task force that recommended them was not constitutionally appointed.
The ACA empowers the U.S. Preventive Service Task Force (USPSTF), the Health Resources and Services Administration (HRSA), and the Advisory Committee on Immunization Practice (ACIP) to determine the types of preventive care that must be covered by health insurers under the ACA. Since the ACA was enacted, these three agencies have issued pronouncements requiring health insurers to cover, at no cost, preexposure prophylaxis (PrEP) drugs for HIV and sexually transmitted disease screenings. These “preventive care mandates,” as the court referred to them, are all recommended by the USPSTF.
The plaintiffs in the case, which included six individuals and two businesses, objected to the preventive care mandates on religious or personal grounds and claimed that they violated the U.S. Constitution and the Religious Freedom Restoration Act (RFRA). In September 2022, Judge O’Connor agreed with respect to the preventive care mandates recommended by the USPSTF, because its members are not confirmed by the U.S. Senate, and neither HHS nor other constitutional officials review their recommendations. (The court’s September 2022 decision did not impact HRSA or ACIP’s recommendations, which include contraceptive care and vaccine recommendations.) The court left unanswered what remedy to issue.
Following supplemental briefing by the parties, the court released its March 30, 2023 decision, in which it issued a universal vacatur of all the USPSTF’s recommendations. The court agreed with the plaintiffs that the Administrative Procedure Act allowed it to vacate HHS’s actions based on USPSTF’s recommendations. It also enjoined HHS from enforcing the USPSTF’s recommended contraceptive coverage requirements in the future. The court also found that it would violate RFRA to require the employer plaintiffs to purchase health insurance that would pay for PrEP drugs to prevent HIV.
The case is Braidwood Mgmt., Inc., et al. v. Becerra, et al., N.D. Tex., No. 4:20-cv-00283. A copy of the court’s decision is available here.
