District Court Rules Against Key Parts of ACA Preventive Services Requirements

On September 7, 2022, the US District Court for the Northern District of Texas issued a ruling in Braidwood Management Inc. v. Becerra, which challenged aspects of the Affordable Care Act’s (ACA) preventive services coverage mandate.

Under the ACA, insurers and group health plans offering non-grandfathered individual or group health coverage must cover certain preventive services without cost-sharing. The covered requirements include services given an “A” or “B” rating from the US Preventive Services Task Force (PSTF), vaccines recommended by the Advisory Committee on Immunization Practices (ACIP), and preventive care and screenings for children and women recommended by the Health Resources and Services Administration (HRSA).

In this case, the plaintiffs include two businesses and six individuals who challenged the preventive-care mandates under the Constitution and the Religious Freedom Restoration Act (RFRA). Each plaintiff wanted to obtain or provide health insurance that excludes or limits coverage currently required by the preventive-care mandates, including PSTF-recommended pre-exposure prophylaxis (PrEP) drugs to prevent HIV infection for individuals who are at high risk of HIV acquisition and HRSA-recommended coverage of contraceptives. They objected to the services required by the preventive-care mandates for a variety of religious and economic reasons. The defendants are the Secretary of HHS, Xavier Becerra; the Secretary of the Treasury, Janet Yellen; the Secretary of Labor, Martin Walsh; and the United States.

The plaintiffs brought five claims against the defendants, including allegations that the ACA preventive-care mandates violate the Constitution's Appointments Clause because the appointment process for members of the PSTF, ACIP and HRSA did not satisfy the constitutional method for appointing officers of the United States. On this issue, the court ruled that the appointment of officers of ACIP and HRSA satisfied the constitutional requirements, but the appointment of PSTF officers did not.

Additionally, the plaintiffs asserted that the PrEP mandate violates the RFRA. On this issue, the court ruled in favor of the plaintiffs. The court determined that the PrEP mandate substantially burdened the exercise of religion by the plaintiffs and that the defendants failed to show that the PrEP mandate furthers a compelling governmental interest and is the least restrictive means of furthering that interest.

On both rulings, the court reserved ruling on the appropriate remedy. The court also did not address the plaintiffs’ objections to contraceptive coverage under the RFRA, although the court is expected to rule on this issue in the future. The court granted summary judgment to the defendants on two other claims brought by the plaintiffs.

Although this order may be appealed, and litigation is ongoing, employers should be aware that a basic ACA requirement is currently under legal scrutiny and monitor future developments.

Braidwood Management Inc. v. Becerra»