Court Vacates Portions of ACA Preventive Services Mandate

A federal trial court has vacated all agency actions taken on or after March 23, 2010, to implement or enforce the preventive health services mandate of the Affordable Care Act (ACA) in response to an “A” or “B” recommendation of the United States Preventive Services Task Force (USPSTF). As background, the ACA requires group health plans and insurers to provide specified preventive services without cost-sharing, including certain evidence-based items and services recommended by the USPSTF, the Health Resources and Services Administration (HRSA), and the Advisory Committee on Immunization Practices (ACIP) (see our Checkpoint Question of the Week). In June 2019, the USPSTF released a recommendation about HIV preexposure prophylaxis (PrEP), triggering a coverage requirement for plan years beginning on or after June 30, 2020 (see our Checkpoint article). This court previously held that the members of USPSTF—but not HRSA or ACIP—were unconstitutionally appointed and thus lack the authority to determine the preventive services that must be covered by private health plans (see our Checkpoint article). The court also held that requiring plan coverage of PrEP violates the Religious Freedom Restoration Act (RFRA).

The court has now vacated as unlawful all agency actions taken on or after March 23, 2010, to implement or enforce the USPSTF-recommended preventive care coverage requirements. The IRS, DOL, and HHS are also blocked from implementing or enforcing coverage requirements in response to such USPSTF ratings in the future. Furthermore, the agencies are specifically blocked from enforcing the PrEP coverage requirement against the religious objectors in the case.

EBIA Comment: As a wholesale invalidation of the USPSTF’s recommendations since the ACA’s enactment, this decision has potentially far-reaching consequences for group health plans. Plan sponsors, service providers, and their advisors should watch closely as it moves through the appeals process. Keep in mind that the HRSA and ACIP recommendations (e.g., covering immunizations and contraceptives) are not currently impacted by the decision. For more information, see EBIA’s Health Care Reform manual at Section XII.C (“Coverage of Preventive Health Services”) and EBIA’s Group Health Plan Mandates manual at Section XIV.C (“Required Preventive Health Services Coverage”). See also EBIA’s Self-Insured Health Plans manual at Section XIII.C.1 (“Preventive Health Services”).

Contributing Editors: EBIA Staff.