This past April, the Texas District Court dealt a heavy blow to a central component of the Affordable Care Act (ACA), the preventive services mandate. In Braidwood v Becerra, the court essentially ruled that the US Preventive Services Task Force (USPSTF) lacks authority to mandate specific services be covered without cost share under this section.

As employers will recall, the ACA requires non-grandfathered group health plans to cover specific preventive services in-network, without imposing any out of pocket cost. These services include:

1. Service with “A” or “B” ratings in the current recommendations of the USPSTF

2. Immunizations for routine use recommended by the Advisory Committee on Immunization Practices (ACIP) of the CDC

3. Preventive screenings for women and children provided in guidelines issued by the Health Resources and Services Administration (HRSA)

The Braidwood Court left services covered in accord with item 1 above in jeopardy. Luckily, the Fifth Circuit provided more clarity to employers this week with their June 13 ruling, upholding their earlier ‘stay’ (or ‘hold off’) from May on the Texas Court’s holding. 

What does this mean? Employers can rely on the current stay being in place, meaning that carriers remain required to cover all preventive services from the above list.

The Fifth Circuit still needs to reach the actual merits of the case which will provide finality (or as final as the law can be until we see the Supreme Court’s view). We will be watching the case closely.