Another Legal Challenge of the ACA Coming Out of Texas and the Fifth District

Cost-Free Preventive Care Under the ACA Faces Legal Challenge, JAMA | JAMA Network, Gregory Curfman, MD; Kirsten Bibbins-Domingo.

The same federal Jackass judge in Texas who struck down the entire ACA (2018) has risen again. In this particular instance, he is taking aim at a core protection of the ACA or Cost-free preventive care. These services range from cancer screening to pregnancy care and have benefited more than 150 million US residents of all backgrounds. The effort has improved health outcomes and helped reduce disparities. Like previous attempts to undercut the ACA, this one stems from a continuing desire to dismantle the law hurt the citizenry (lets be honest here), stifle administrative agencies, and undermine Congress’ authority to design federal programs. It also stems from animus discrimination toward LGBTQ+ individuals and those with substance use disorder. There is no rational legal or otherwise for the judge’s actions and what they promote.

Approximately 13 years to the date of its enactment, it is remarkable to see a fight to overturn the ACA sill existing. The statute has survived an unprecedented 8 trips to the US Supreme Court and almost 100 attempts at repeal.

The ACA has also proved itself to become the US’ health workhorse, rising to swell the safety net to support the nation through the pandemic. Along the way it still enables some 35+million individuals to obtain affordable, quality insurance. Of which enabling 21 million of them with low incomes coming from the ACA’s Medicaid expansion. Most people in the US do not begin to realize how they benefit from the ACA every single day.

And here we are again, with the same characters, acting out civil and legal arguments in an attempting to disenfranchise millions of people by overturning the ACA. Overturn a portion of the ACA to start.

The lawsuit, Braidwood Management v Becerra, was brought by individuals and businesses who have religious or moral objections to some preventive services, or simply don’t want to pay for some of them. Among services specially targeted were ACA mandates that covered contraception, the human papillomavirus vaccine, sexually transmitted disease and drug screenings, and PrEP. Same old characters with the same ideology which they cast as religion.

Religious employers argued these particular preventive services “encourage” behavior they find objectionable, including homosexual behavior, injection drug use, and sex outside of marriage. While there is no evidence that preventive services “encourage” such behaviors, the plaintiffs argued that providing insurance coverage makes them “complicit.” The lawsuit argues that religious freedom is a trump card over access to health care and nondiscrimination. It is easy to see a slippery slope here, if employers can simply object to coverage for any preventive care services they associate with behavior they find distasteful or just plain dislike.

The lawsuit argues that this entire structure of expert assessments of effective clinical services is unconstitutional. In support of their claim, the challengers advance a variety of constitutional theories that have become increasingly common in attacks on the administrative state, including the argument that members of these expert bodies had to be appointed directly by the president or department head and that the bodies had too much discretion.

The judge did not bite on the challenges to preventive services required by ACIP and HRSA, finding the secretary of Health and Human Services with sufficient control over those processes. Importantly, Congress did provide clear guidelines for all 3 expert panels by requiring them to use rigorous scientific evidence in their decisions, and defining the populations and areas, such as women’s health, for each panel’s focus.

But the court did invalidate all of the preventive services since the ACA was enacted that were authorized by the USPSTF—a volunteer group of the nation’s finest health scientists who have been recommending services that prevent disease and protect health for nearly 40 years. This has immense implications for the ACA, which requires most health plans to cover USPSTF “A” or “B” recommendations without cost sharing—clinical prevention services with a high certainty of substantial or moderate net benefit.7 In so doing, the judge wiped out coverage for many health services, including vital screenings for cancers, high blood pressure, hepatitis B and C, and much more. The court also found merit in the religious objection to insurance coverage for PrEP, despite the finding of the Centers for Disease Control and Prevention that PrEP reduced lifetime HIV infection risk from 44% to 66%, with increased life expectancy.8The ruling has already sown enormous confusion in the medical community because clinicians do not know what services remain covered without cost to their patients.

Sorry if you find my views distasteful. I do not find merit in religious objections to health and medical care for supposed devil’s doings. It is a silly argument based upon bigotry mostly. It is in appeal at the Fifth District COA which definitely leans towards burning the heretics at the stake. The Feds and the pseudo-Christians will battle this out to SCOTUS. Where was again we will discover whether the court decides we are a nation of all or religion.

Thirteen years of seeking to dismantle or weaken the ACA has hurt all of us. The courts should put an early end to this lawsuit and ensure the continued availability of cost-free preventive health care, a critical recent intervention on which hundreds of millions of US residents have come to rely.

SCOTUS should also decide whether this judge should still be a judge or retire.

SCOTUS Rules 7-2 in Favor of ACA, Angry Bear, angry bear blog