WASHINGTON — A federal judge in Texas who once declared the Affordable Care Act unconstitutional issued a far-reaching ruling on Thursday that prevents the Biden administration from enforcing a provision of the law that provides patients with certain types of free preventive care, including screenings for cancer, depression, diabetes and H.I.V.
The decision, by Judge Reed O’Connor of the Federal District Court for the Northern District of Texas, applies nationwide. If it stands, it could have far-reaching implications for millions of Americans, and bring the United States back to the days before the 2010 health law known as Obamacare, when insurers were free to decide which preventive services they would cover.
The ruling, which is in the form of a nationwide injunction, takes effect immediately, said Lawrence O. Gostin, an expert on health policy at Georgetown University who has followed the case. It will affect a long list of preventive care services, he said, including services like screenings for heart disease, pap smears and tobacco cessation services.
“It might be that tomorrow, a woman might wake up and find that her mammogram is not covered,” Mr. Gostin said, adding, “I think we forget what it was like before the Affordable Care Act, where we had to pay and it was unaffordable for basic primary health care services.”
The Biden administration is likely to appeal the ruling and ask for a stay of the injunction. The White House press secretary, Karine Jean-Pierre, said the Justice Department and the Department of Health and Human Services were reviewing the decision.
The Fight Against H.I.V.
An estimated 40 million people are living with H.I.V. worldwide. About 10 million of them do not have access to treatment.
- A Lifesaving Program: In the 20 years since its inception, the President’s Emergency Plan for AIDS Relief has delivered H.I.V. treatment to more than 20 million people in 54 countries, according to a new report.
- Injectable PrEP: An injection every two months rather than a daily pill could shield many more women from H.I.V., but the shot is unavailable in places that need it most.
- The Search for a Vaccine: Janssen Pharmaceuticals ended a global trial after experts determined the vaccine was not effective. But there are other possibilities in the pipeline.
- Left Behind: Sub-Saharan Africa has made steady progress in delivering lifesaving medication to adults. But young patients are harder to reach.
“This case is yet another attack on the Affordable Care Act,” Ms. Jean-Pierre said, adding, “Preventive care saves lives, it saves families money and protects and improves our health.”
The lead plaintiff in the case is Braidwood Management; the company’s owner, Dr. Steven F. Hotze, is a well-known Republican donor and Houston doctor who has previously challenged the Affordable Care Act. The plaintiffs argued that a volunteer panel of experts that issues binding recommendations on what preventive care must be covered under the law violated the Constitution because its members are not appointed by the president or confirmed by the Senate.
The plaintiffs also singled out drugs that prevent H.I.V./AIDS, arguing that the mandate to cover those medicines violated the Religious Freedom Restoration Act, a 1993 law that prevents the government from imposing a burden on a person’s religious freedom.
“This decision introduces uncertainty into an aspect of the health care system that people have benefited from for nearly a decade: access to preventive care with no out-of-pocket costs,” Natalie Davis, the chief executive of United States of Care, a nonpartisan health advocacy group, said in a statement.
Ms. Davis said the ruling meant that nearly half of Americans — more than 151 million people — “may lose access to free preventive services, such as mental health, weight loss measures and various cancer screenings that we have all come to depend on.” But she said that people who have private coverage secured in yearlong contracts might not experience changes until those contracts are renewed.
Advocates for people with H.I.V./AIDS were especially alarmed at the decision.
“The fact that a judge in Texas has decided to threaten the health care of all Americans for fringe ideological beliefs is something that should truly scare every American,” said James Krellenstein, a longtime H.I.V./AIDS activist.
Judge O’Connor’s ruling was not a surprise. In September, he ruled that the U.S. Preventive Services Task Force — a volunteer panel of experts that recommends what kinds of preventive care must be covered under the Affordable Care Act — violated the Constitution. Thursday’s ruling flows out of that earlier decision.
The ruling in September also took explicit aim at the H.I.V. drug regimen known as pre-exposure prophylaxis, or PrEP, saying the law’s requirement that it be fully covered violated Braidwood Management’s religious freedom.
Thursday’s ruling comes just a week after the 13th anniversary of President Barack Obama’s signing the measure into law. In 2012, the Supreme Court upheld the bulk of the law but struck down its requirement that states expand Medicaid. In 2018, Judge O’Connor ruled that the entire law was unconstitutional, but the Supreme Court later overruled him.
