U.S. judge blocks Obamacare coverage mandate for some cancer screenings, PrEP

[March 31, 2023]  By Brendan Pierson

(Reuters) - A federal judge in Texas on Thursday blocked Obamacare's mandate that health insurance plans cover preventive care, including screenings for certain cancers and pre-exposure prophylaxis against HIV (PrEP), at no cost to patients.

U.S. District Judge Reed O'Connor in Fort Worth, Texas, previously found that the PrEP mandate violated a federal religious freedom law and that other no-cost preventive care mandates were based on recommendations by an illegally appointed task force.

The judge has now blocked the federal government from enforcing the mandates, a victory for conservative businesses and individuals that sued to challenge them in 2020. The ruling does not apply to preventive services, such as breast cancer screening, that were recommended before Obamacare, formally called the Affordable Care Act (ACA) was enacted in 2010.

White House spokesperson Karine Jean-Pierre said the Biden administration was reviewing the decision.

More than 150 million people were eligible for preventive care free of charge as of 2020 under the ACA, according to data from the U.S. Department of Health and Human Services. If O'Connor's ruling is not paused or overturned on appeal, insurers will be able to charge patients copays and deductibles for such services in new insurance plans.

AHIP, the health insurance industry's largest trade group, said there would be no immediate coverage interruptions.

"Every American deserves access to high-quality affordable coverage and healthcare, including affordable access to preventive care and services that help avoid illnesses and other health problems," said AHIP President Matt Eyles.

Major medical groups criticized the decision. American Medical Association President Jack Resneck called it "deeply flawed" and said that patients "will be subjected to needless illness and preventable deaths" as a result.

Lisa Lacasse, president of the American Cancer Society Cancer Action Network, said the ruling could have "huge implications" and make it more difficult to catch treatable cancers early.

"We cannot emphasize enough how important screenings are for early detection of cancer," she said.

A sign on an insurance store advertises Obamacare in San Ysidro, San Diego, California, U.S., October 26, 2017. REUTERS/Mike Blake

The American College of Obstetricians and Gynecologists, in a statement, said: "Allowing personal or political bias to interfere with the practice of medicine will cause harm to our patients."

The legal challenge was brought by eight individuals and two businesses, all from Texas. They argued that the free PrEP requirement requires business owners and consumers to pay for services that "encourage homosexual behavior, prostitution, sexual promiscuity and intravenous drug use" despite their religious beliefs.

They also said that the advisory body that recommends what preventive care should be covered without cost, the Preventive Services Task Force, is illegal because its members are not directly appointed by the president, which they argue is required by the U.S. Constitution.

The task force's recommendations automatically become mandatory under the Affordable Care Act.

The conservative America First Legal Foundation is helping to represent the plaintiffs. The group was founded by Stephen Miller, who served as an adviser to Republican President Donald Trump.

O'Connor previously drew attention in 2018 for ruling the entire ACA, the signature achievement of Democratic then-President Barack Obama, was unconstitutional in a decision that was later overturned.

The PrEP drugs approved in the United States to prevent HIV infection, which can cause AIDS, are made by Gilead Sciences Inc and by ViiV Healthcare, a joint venture of GSK Plc, Pfizer Inc and Shionogi & Co Ltd.

GSK and ViiV said in a statement that they were "concerned about any court order or policy that could negatively impact access to important health prevention services, including PrEP for HIV" and supported an appeal of O'Connor's order.

(Reporting By Brendan Pierson in New York and Ahmed Aboulenein in Washington; Editing by Mark Porter and Jonathan Oatis)

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