Preserving Access to Preventive Services

A lawsuit filed in Texas challenges the provisions of the Affordable Care Act (ACA) that require private insurers to cover preventive services recommended by the US Preventive Services Task Force (USPSTF), Advisory Committee on Immunization Practices (ACIP) and Health Services and Resources Administration (HRSA) without copay as constitutionally flawed in the case of Braidwood Management v. Becerra.

The plaintiffs also originally claimed they should not have to provide insurance that covers PrEP, a drug that helps prevent HIV-1, because they believed it encourages immoral behavior and violated their rights under the Religious Freedom Restoration Act (RFRA). In September of 2022, US District Court Judge Reed O’Connor struck down the ACA provision with respect to the USPSF, and sided with plaintiffs on the RFRA claim as well.  He considered potential remedies to correct the flaw, putting treatments such as proven screenings for colorectal, cervical, and lung cancers at risk.  ACS CAN led 16 patient groups representing millions of people with serious health conditions in this amicus brief providing scientific data on how preventive services save lives and are cost-effective.  Read our statement. 

The RFRA claims eventually settled.  Unfortunately, in March of 2023, Judge O’Connor ruled that the Department of Health and Human Services could no longer enforce the USPSTF provision of the ACA against insurers, finding all mandates based on recommendations since March of 2010 were invalid.  Patient groups urged the US Court of Appeals for the Fifth Circuit to issue a stay. Read our amicus brief and our statement. The Fifth Circuit granted an administrative stay in mid-May, which later evolved into a full stay when the circuit court approved a settlement in which the parties agreed the remedies should only apply to plaintiffs during the litigation.  The stay should guarantee patients barrier-free access to the services while the litigation continues.  ACS CAN applauded the stay when it was issued. 

The case was cross-appealed, meaning plaintiffs and government defendants all appealed the USPSTF, ACIP and HRSA claims they lost to the Fifth Circuit. ACS CAN led patient groups in filing an amicus brief at the end of June, 2023 to provide the court with scientific evidence demonstrating that access to ACIP-, HRSA- and USPSTF-recommended services increase access to care, improve treatment options, save lives, and are cost-effective. Read our statement.

The Fifth Circuit issued its decision in June of 2024.The court affirmed the district court’s opinion that the USPSTF structure was unconstitutional, but it drastically changed the remedy from being “universal” and affecting over 150 million people to only applying to the plaintiffs in the case. ACS CAN and its amici partners issued this statement applauding the decision. However, the circuit court left open the possibility of a different outcome for ACIP and HRSA recommendations if the plaintiffs were to sue using a different law, the Administrative Procedures Act (APA). The Fifth Circuit remanded these issues back down to the district court to determine whether the ACIP and HRSA recommendations actually had been properly ratified by the Secretary, or were not ratified and must be thrown out. 

The government and plaintiffs cross-appealed by filing petitions for certiorari at the US Supreme Court. The government appealed the USPSTF ruling, while the plaintiffs appealed the ACIP and HRSA ruling. ACS CAN led 35 patient, provider and physician groups by filing an amicus brief supporting the government’s petition. Read our statement. In January, 2025, the Supreme Court granted the government’s petition to hear the appeal on USPSTF, and denied the plaintiffs petition on ACIP and HRSA. ACS CAN and its partners applauded the Supreme Court’s decision to accept the USPSTF appeal in the case. On February 18, the government filed its brief on the merits in the case, defending the provision of the ACA at issue. Public health groups applauded. On February 25, ACS CAN led another amicus brief filed at the US Supreme Court providing extensive scientific evidence on how preventive care such as colon, breast and lung cancer screenings save lives and are cost effective.  Read our statement. Oral arguments are scheduled for April 21, 2025.