Brendan Pearson
(Reuters) – A U.S. appeals court on Friday refused to block a federal mandate requiring health insurers to cover preventative services such as cancer screenings and HIV prevention drugs at no additional cost to patients, but ruled against the government on a key legal issue , which leaves the future of the mandate in doubt.
A panel of the 5th U.S. Circuit Court of Appeals unanimously agreed with a group of Christian businesses that filed a lawsuit challenging the mandate, arguing that the way services are selected for coverage violates the U.S. Constitution.
However, the panel found that U.S. District Judge Reed O’Connor in Fort Worth, Texas, went too far in blocking the nationwide mandate in March 2023 and instead blocked its enforcement only against the businesses that filed the lawsuit. O’Connor’s decision was deferred while the case was heard by the Court of Appeal.
The largest U.S. medical groups said eliminating the preventive care mandate would put patients at risk and increase health care costs.
The panel also ordered O’Connor to reconsider his decision to support mandatory coverage for certain vaccines and screening services for children, which businesses also challenged. The commission said O’Connor failed to consider some important legal issues, although it did not weigh what decision he should make.
While the 5th Circuit’s ruling allows the government to continue to enforce the mandate, it may provide support to other employers or insurers looking to challenge it.
The plaintiffs were represented by the conservative group America First Legal. Gene Hamilton, the group’s executive director, in a statement called Friday’s decision “a victory for the Constitution, the rule of law and every American who doesn’t want unelected bureaucrats making decisions about their health insurance.”
The U.S. Department of Health and Human Services (HHS) did not immediately respond to a request for comment.
In their 2020 lawsuit, the companies objected to covering HIV pre-exposure prophylaxis (PrEP) on religious grounds, but also argued that the entire mandate violates the U.S. Constitution because an HHS-appointed task force chooses which treatments should be covered. They said a task force with such powers would have to be appointed by the president and confirmed by the Senate.
Both O’Connor and the 5th Circuit agreed with that argument, and the 5th Circuit rejected the government’s contention that HHS Secretary Xavier Becerra could solve the problem retroactively by “ratifying” the task force’s decisions.
Two members of the panel, Circuit Judges Don Willett and Corey Wilson, were appointed by former Republican President Donald Trump. The third, Circuit Judge Irma Carrillo Ramirez, was appointed by President Joe Biden, a Democrat.
The preventive care mandate is part of the 2010 Affordable Care Act, often called Obamacare because it was championed by then-President Barack Obama. O’Connor attracted widespread attention in 2019 by ruling that the entire law was unconstitutional, but that decision was later overturned.
His ruling on the preventive care mandate did not cover preventive services that the task force recommended before the ACA, including breast cancer screening.