Fifth Circuit Ends Nationwide Injunction on ACA Preventive Service Rules

On June 21, 2024, the Fifth Circuit Court of Appeals ended a nationwide injunction blocking federal agencies from enforcing the recent disputed Affordable Care Act’s (ACA) preventive health service mandates.

However, in its ruling, the Fifth Circuit agreed with a lower court’s decision that the mandates could not be enforced against the parties that brought the litigation. This means that, for now, health plans and health insurance issuers must continue to provide first-dollar coverage for the full range of recommended preventive health services.

ACA Preventative Services Background:

The ACA requires non-grandfathered health plans and issuers to cover a set of recommended preventive services without imposing cost-sharing requirements, such as deductibles, copayments, or coinsurance, when the services are provided by in-network providers. The recommended preventive care services covered by these requirements are:

• Evidence-based items or services that have a rating of “A” or “B” as currently recommended by the USPSTF except 2009 regulations regarding breast cancer screening, mammography, and prevention.
• Immunizations for routine use in children, adolescents, and adults that have a recommendation from the Advisory Committee on Immunization Practices of the CDC
• Evidence-informed care for infants, children, and adolescents found in the comprehensive guidelines supported by the Health Resources and Services Administration (HRSA)
• Preventive care and screening for women in a comprehensive guideline supported by the HRSA

In March 2023, the U.S. District Court for the Northern District of Texas struck down a key component of the ACA’s preventive care mandate. The District Court ruled that the preventive care coverage requirements based on an A or B rating by the United States Preventive Services Taskforce (USPSTF) on or after March 23, 2010, the ACA’s enactment date, violate the U.S. Constitution.

For now, health plans and health insurance issuers must continue to provide first-dollar coverage for the full range of recommended preventive health services.

The USPSTF is a panel of experts in primary care and prevention who make recommendations regarding which preventative services should be covered, which are then often adopted by HHS. The District Court issued a nationwide injunction, prohibiting the Biden administration from enforcing the affected preventive care mandates against any health plans or issuers.

The Biden administration appealed the District Court’s ruling to the Fifth Circuit, which covers Texas, Louisiana, and Mississippi. The Fifth Circuit put the District Court’s decision on hold pending its ruling, which means health plans and issuers have been required to fully comply with the ACA’s preventive care mandate without interruption.

For additional guidance on Affordable Care Act compliane, check out our ACA reporting cheat sheet.