The long-awaited decision in Braidwood Management v. Becerra was announced last week (3/30) and an appeal has already been filed. Given US District Judge Reed O’Connor’s previous decisions and rulings in the case, it was not a surprise that he struck down the Affordable Care Act’s requirement that health plans cover, without cost sharing, certain preventive services recommended by the U.S. Preventive Services Task Force (USPTF). This includes screenings for HIV, cancers, suicide risk, and Hepatitis C. O’Connor also found that the ACA’s coverage requirement for preexposure prophylaxis (PrEP) for HIV “substantially burdens” employer plan sponsors with conservative religious views and violates the Religious Freedom Restoration Act of 1993. 

While this decision is sorely disappointing given the millions of people who have benefited from the ACA’s preventive services requirements over the past decade, Washington residents can rest assured that efforts are ongoing to preserve these benefits. The case is being appealed and the appellate court may stop the lower court ruling from impacting benefits during the appeal. In addition, Washington is one of fifteen states that protect the ACA preventive services through state law. Passed in 2018, Washington’s law applies to fully insured, but does not extend to self-insured/ERISA plans. That means those who get coverage through their employer could eventually be affected if the lower court ruling stands, but Washington Insurance Commissioner Mike Kreidler sent a letter to Washington health insurers asking each carrier to indicate whether they plan to continue offering all services with an “A” or “B” rating from the USPTF for the 2024 plan year and requesting a response by April 11th. 

To be clear, the Braidwood decision does not eliminate all free preventive services. Continuing will be those that had an “A” or ”B” recommendation before the ACA became law and preventive services recommended by other entities, such as the Advisory Committee on Immunization Practices (ACIP) and the Health Resources and Services Administration (HRSA). Policy experts say it is likely insurers won’t immediately halt preventive services coverage, but if the ruling is upheld, they could impose potentially burdensome cost-sharing on some preventive care and on PrEP drugs, in particular.  But some states aren’t waiting and are already responding to the Braidwood decision. Michigan’s Governor Gretchen Whitmer directed the Michigan state Department of Insurance and Financial Services to protect potential loss of health insurance coverage for preventive services that include colon and lung cancer screenings, and preventive drugs for breast cancer, heart disease, and HIV. The Department of Justice filed an appeal in Braidwood and may seek a stay while the case is on appeal. It is expected that this case will be heard by the Supreme Court. This KFF article includes helpful information on the case’s implications.