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Healthcare

The North Texas Ruling Remaking Health Insurance Plans

Advocates are working to make sure insurance plans in Texas can't remove preventive care from employer-sponsored health plans.
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Courtesy: iStock

A North Texas federal court ruling overturning an Affordable Care Act provision will allow employers to offer health insurance plans that don’t include preventive services. Dozens of national healthcare organizations expressed their disappointment at the ruling, and North Texas state legislator Nathan Johnson filed a bill to ensure that Texas plans maintain preventive care.

The case in question, Braidwood Management v. Becerra, involved Christian-owned business and six individuals who felt that the ACA provision requiring health insurance plans to provide preventive care without cost-sharing was unconstitutional and claimed that the requirement to cover medication for HIV prevention, contraception, and screening and counseling for STDs is a violation of their religious rights.

The plaintiff’s “claim that compulsory coverage for those services violates their religious beliefs by making them complicit in facilitating homosexual behavior, drug use, and sexual activity outside of marriage between one man and one woman,” court documents say.

But the preventive services provision guaranteed that employers offered insurance plans and other services. Evidence-based screenings for cancer, depression, heart disease, and other conditions, counseling, routine immunizations, breastfeeding services, hepatitis infection screening, hypertension screening, well-women visits, weight loss prevention, and more were all required in health insurance plans. Employers can now offer health plans that don’t include these services.

After making a rule partly in favor of the plaintiff last fall, the George W. Bush appointee Judge Reed O’Connor ruled that the federal government cannot make employers include preventive care coverage in the health plans they offer their employees and that the ACA requirement is a violation of employers’ rights under the Religious Freedom Restoration Act.

In response to the ruling, several healthcare organizations expressed disappointment and asked the Department of Justice to appeal the decision. The American Heart Association, American Lung Association, March of Dimes, Susan G. Komen, the Epilepsy Association, and others are worried that the change will create financial burdens to seeking these services.

“Since the Affordable Care Act (ACA) was signed into law in 2010, more than 150 million Americans – including those covered by employer-sponsored, ACA marketplace and Medicaid expansion plans – have benefitted from no-cost preventive services like cancer screenings, help to quit smoking, HIV prevention, blood pressure tests, and many other healthcare services. This has not only saved lives, but studies show that high-quality coverage, complete with preventive services, improves the overall health of individuals and our country, lowers overall health spending, and reduces health disparities,” they said in a statement.

With the writing on the wall for the ruling to change how insurance plans are written, North Texas state senator Nathan Johnson filed a bill to ensure that all Texas plans to offer these services. His Senate Bill 2247 seeks to incorporate the ACA’s preventive care requirements into the Texas Insurance Code. The recent ruling makes his bill more imperative, he says.

Though inspired by religious conviction, the ruling results in a move toward free-market decision-making that puts the onus on the employee or consumer to ensure the plan they choose offers what they need. But critics say that health insurance is not a true market and needs guard rails to help employees get the care they need that prevents issues from becoming more expensive if left untreated.

“Many types of insurance that we require, like homeowners and car insurance, have requirements for things that must be covered in those plans,” Johnson says. “These requirements are considered the most beneficial for their health and overall costs in the insurance market.”

Other opponents call the ruling judicial overreach that targets the LGBTQ community, citing the loss of PrEP medication that helps prevent the transmission of HIV. “Whether it’s access to abortion, gender-affirming care, birth control, or PrEP, we are seeing dangerous action from rogue activist judges forcing themselves into Americans’ private health care decisions,” said Adam Polaski, the communications director at the Campaign for Southern Equality.

Johnson says the ruling will likely generate more discussion around his bill now that the insurance plan changes are a reality. For him, the cost savings on the front end by offering a cheaper plan without preventive services is a financial and ethical mistake.

“You may have people buying cheaper policies, but if they don’t get screenings, they may develop cancer,” he says. “I would rather them be diagnosed with a polyp than stage 4 cancer. Cutting off access shifts patients from a healthcare regime to a sick care regime.”

Time will tell what types of health plans will be built as a result of the ruling, but there are more options for employers and their employees to choose from either way. Senate Bill 2247 has been referred to the Health & Human Services committee in this year’s legislative section.

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Will Maddox

Will Maddox

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Will is the senior writer for D CEO magazine and the editor of D CEO Healthcare. He's written about healthcare…

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