Court reverses judge’s block of some Obamacare no-cost preventive care coverage mandates nationwide

A conservative appeals court on Friday reversed aspects of a ruling that would have blocked nationwide Affordable Care Act requirements that certain preventive services be covered by insurers at no cost, including several cancer screenings and a popular heart medication.

However, the 5th US Circuit Court of Appeals upheld a trial judge’s conclusions that some of the no-cost coverage mandates were unlawful because the federal task force that recommended what preventive services should be covered under the mandates violated the Constitution.

The case centers on the recommendations for no-cost coverage mandates that have been issued by the US Preventive Services Task Force, as well as those issued by the Advisory Committee on Immunization Practices and by the Health Resources and Services Administration.

US District Judge Reed O’Connor in Texas had previously struck down the recommendations issued by the US Preventive Services Task Force that were not already in place at the time the Affordable Care Act was signed into law in 2010, agreeing with the challengers’ argument that the task force violated the Constitution’s appointments clause.

Had his ruling gone into effect nationwide, it would have invalidated the no-cost coverage mandates for some cancer screenings, the use of statins to prevent cardiovascular disease, and counseling referrals for pregnant and postpartum women at increased risk of depression, as well as for the HIV-prevention measures known as PrEP. (O’Connor also stuck down the PrEP mandate on the claim that it violated the Religious Freedom Restoration Act.)

With its new ruling, the 5th Circuit – which covers Texas, Louisiana and Mississippi – set a precedent that will control for any other case brought in those states where the challengers are also seeking exemption from the mandates under the same appointments clause claim. That means that although the 5th Circuit significantly narrowed the scope of the current case, it could still have a major impact on the law’s reach for millions of Americans.

Friday’s ruling also sets up what could be the next Supreme Court clash over the Affordable Care Act, which has been under relentless legal attack by the right since it was enacted in 2010.

The Justice Department declined to comment. The Department of Health and Human Services did not immediately respond to CNN’s request for comment. A lawyer for the challengers also has not offered comment on the case.

The 5th Circuit sent parts of the case back to the lower court for more proceedings concerning the constitutionality of the other two entitles targeted in the lawsuit, the Advisory Committee on Immunization Practices, and by the Health Resources and Services Administration – which, respectively, issue recommendations for no-cost vaccine coverage and for preventive services for women and children.

In its Friday ruling, the 5th Circuit said it was inappropriate for the trial judge to issue the sweeping order – which had already been paused for appeal – that would have halted for the entire country some of the mandates from the task force, given that the individuals and businesses that brought the lawsuit were already being shielded any from enforcement action being brought against them under the Affordable Care Act.

“Although all the services remain nationwide, the battle is far from over. The plaintiffs get another bite at the apple to challenge HRSA and ACIP recommendations,” said Andrew Twinamatsiko, a director at the O’Neill Institute for National and Global Health Law at Georgetown University.

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