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ACA Preventive Services Ruling: Insights and Key Takeaways for Plan Sponsors


In this article, Joanne Roskey reviews the recent court decision in Braidwood Mgmt., Inc. v. Becerra, that upended the certainty employers and health plan participants were accustomed to regarding which items and services fall under the Affordable Care Act (ACA) preventive services mandate and who pays for them. A federal judge in Texas struck down a key provision that insurers and employers cover free preventive screenings for cancer, heart disease, HIV and other diseases. The decision threatens access to over 100 million Americans who use these services, which include mammograms and STD testing. Both sides in the Braidwood litigation have filed notices of appeal indicating their desire for the U.S. Court of Appeals for the Fifth Circuit to review the district court's March 30, 2023, decision, and there is no shortage of issues the parties can potentially raise on appeal. What is certain is that the appellate court will be called upon to address a host of complex legal issues and, when deciding those issues, will have the views of not only the parties in the case but also from an array of interested third parties who will file briefs attempting to influence the outcome of the appeal. The author discusses some of the issues likely to be raised on appeal in this high-profile case. Roskey concludes that as it currently stands, a nationwide injunction is in full force, with many employers and insurers opting to wait out the appeals process before considering whether to make changes to their health plans' coverage in response to the decision.