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A federal judge in Texas ruled Wednesday that the Affordable Care Act’s process for determining what kinds of preventive care must be fully covered by private health insurance is unconstitutional, ramping up yet another legal battle over the 12-year-old law. The ruling, by Judge Reed O’Connor of the United States District Court for the Northern District of Texas, could jeopardize millions of Americans’ access to preventive services, including cancer screenings, alcohol abuse counseling and drugs that prevent H.I.V. infection. It does not take effect immediately, however, and legal experts said the Biden administration would almost certainly appeal. (Stolberg, 9/7)

In the case at hand, Braidwood Management Inc. et al. v. Becerra, six individuals and two businesses challenged the legality of the preventive care mandates under the Constitution and Religious Freedom Restoration Act. The latter prohibits any government agency from substantially burdening an individual’s religious practice. Braidwood provides health insurance to employees but objected to coverage for PrEP because the plaintiff believes the Bible is “the authoritative and inerrant word of God." The company argued that providing coverage of PrEP drugs "facilitates and encourages homosexual behavior, intravenous drug use, and sexual activity outside of marriage between one man and one woman." (Cohen, 9/7)

The legal challenge argued that the free pre-exposure prophylaxis, or PrEP, requirement, as well as free coverage requirements for contraceptives and the human papillomavirus (HPV) vaccine, requires business owners to pay for services that "encourage homosexual behavior, prostitution, sexual promiscuity and intravenous drug use" despite their religious beliefs. (Pierson, 9/7)

The ruling was handed down by U.S. District Judge Reed O’Connor, whose courtroom in Fort Worth is a favored venue for conservative opponents of the federal health care law that’s also known as “Obamacare.” He ruled in 2018 that the entire law is invalid but was later overturned by the U.S. Supreme Court. ... O’Connor also ruled that a federal task force that recommends coverage of preventive treatments, which is made up of volunteer members, violates the appointment clause of the U.S. Constitution. (Weber, 9/7)

Under the ACA, health insurers are required to cover an array of preventive health services — like cancer screenings and vaccines — at no cost. In particular, any service or drug that gets an “A” or “B” rating from the U.S. Preventive Services Task Force must automatically be added to that list of free services. ... The list price of brand-name PrEP drugs also is more than $22,000 annually. But O’Connor argued the government does “not show a compelling interest in forcing private, religious corporations to cover PrEP drugs with no cost-sharing and no religious exemptions.” (Herman, 9/7)

The Biden administration announced Wednesday night it was reviewing a Texas judge’s ruling that declared a part of the Affordable Care Act (ACA) requiring that health care employers provide HIV preventive drugs unconstitutional. White House press secretary Karine Jean-Pierre tweeted the administration was reviewing the decision because the ACA “has been the law of the land for over 10 years.” (Dress, 9/7)