A March 30, 2023 ruling by a Texas federal judge brings uncertainty to the ACA mandate on preventive care coverage

On Thursday, March 30, 2023, a Texas federal judge invalidated the Affordable Care Act (ACA) mandate requiring insurers to cover specific preventive services for free, such as certain cancer screenings and medicines for preventing heart disease. The ruling, which took place immediately, could affect over 150 million Americans’ out-of-pocket costs for these services. Immediate implications are unclear, and health experts don’t expect significant short-term changes. The Biden administration is expected to appeal the decision, which could lead to further legal proceedings.

Judge’s Ruling and Its Implications

U.S. District Judge Reed O’Connor, known for critiquing Obamacare, argued that the U.S. Preventive Services Task Force’s role is improper under a constitutional “appointments clause” since its recommendations do not receive approval from presidential appointees. The task force, an independent group of experts, determines which preventive services insurers should cover for free.

The ruling doesn’t apply to all preventive care dictated by the task force but rather to decisions made after the ACA or updated recommendations. For now, it’s up to insurers and employers to decide whether to continue free coverage of certain care. Health experts don’t expect significant short-term changes, but if the ruling isn’t reversed, some predict insurers might still cover preventive services but require patients to pay part of the cost.

The Future of Preventive Care Coverage

While the immediate implications of the March 30, 2023 ruling are murky, insurance companies typically do not revise their plans mid-year. The main insurers’ lobby sought to assure the public that there would be “no immediate disruption in care of coverage.” The Biden administration is expected to appeal the decision, and federal officials are currently reviewing the ruling.

According to the Washington Post, Andrew Twinamatsiko, an associate director of Georgetown’s Health Policy and the Law Initiative at the O’Neill Institute, noted that insurers and employers might be hesitant to make changes during an ongoing legal battle. However, he acknowledged that the situation creates a “wild, wild West of anything goes” since there is no obligation to maintain current coverage.

The Benefits of Free Preventive Care

Despite the uncertainty surrounding the future of preventive care coverage, there may be incentives for companies to continue providing free preventive care. The health policy world has long debated whether prevention saves the nation’s health system money, but there is an array of evidence that shows it translates into healthier patients.

According to CNN, Cynthia Cox, a vice president at the Kaiser Family Foundation, said at a press briefing, “It’s not necessarily the case that all insurers would even want to impose cost-sharing on some of these preventive services cause they might see it as beneficial.”


The recent March 30, 2023, ruling on the ACA preventive care coverage mandate brings uncertainty to the future of preventive care in the United States. While the short-term implications may be limited, the long-term effects depend on the outcome of the legal battle and insurers’ decisions regarding coverage. As the situation unfolds, it is crucial for Americans to stay informed and be prepared for potential changes in their healthcare coverage.

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