A legal assault on preventive care
A federal judge in Texas has “struck down a major part of the Affordable Care Act,” in a ruling that could “worsen health-care costs for millions of Americans,” said Matt Ford in The New Republic. Judge Reed O’Connor ruled unconstitutional a provision requiring insurers to fully cover an array of preventive-care measures, such as prenatal care, mammograms, and screenings for other common forms of cancer. It’s the fourth time O’Connor has ruled parts of the ACA unconstitutional; in 2018, he struck down the entire act with a ruling “so preposterous it was widely condemned by legal experts” and overturned 7-2 by the Supreme Court. This time he sided with a Christian business owner who objected to his employees’ plans covering PrEP drugs that prevent HIV transmission. O’Connor ruled that because decisions about mandatory preventive-care coverage are made by a panel of experts who aren’t appointed by the president or confirmed by the Senate, those mandates violate the Constitution.
“The list of services that could become out of reach for many people is long,” said Pema Levy in Mother Jones. Nobody’s coverage will change immediately; for one thing, the Biden administration has requested a stay pending appeals. But if the ruling stands, health insurers would no longer have to fully cover prenatal care, cholesterollowering drugs, STD screenings, or cancer screenings such as colonoscopies. That would “have a disastrous outcome for health care in the U.S.,” said Lisa Jarvis in Bloomberg. Preventive care saves hundreds of thousands of lives every year, and numerous studies have shown most people will forgo it if it costs even a $25 co-pay.
O’Connor is unlikely to “have the final word,” said Ian Millhiser in Vox. Still, if this case reaches the U.S. Supreme Court, it may “get even worse for patients.” There are three government bodies that set standards for preventive care, and O’Connor invalidated only one of them. He said “binding precedents” tied his hands in the case of the other two, which set guidelines for vaccinations and some preventive care for women and children. But the Supreme Court has “the power to overrule those precedents.” And in a 2020 ruling, five of the court’s six conservative justices questioned the power of all three bodies. So thanks to Republicans’ “capture of the federal judiciary,” U.S. health coverage “could get worse— potentially much worse—in the near future.”