Court Ruling May Bring Back Copays for Preventive Health Services

By D. Mark Wilson posted 09-23-2022 00:00


A U.S. District Court Judge effectively struck down an ACA mandate requiring employer health plans to provide first-dollar coverage for certain preventive service recommendations by the U.S. Preventive Services Task Force.

Background: Since 2010, the Affordable Care Act (ACA) has required employer health plans to cover all of the “A” and “B” recommendations the U.S. Preventive Services Task Force (USPSTF) publishes without charging deductibles or copayments.

The court ruled that because the USPSTF is independent of HHS and its members are not nominated by the president and confirmed by the Senate, the Task Force violates the appointments clause of the U.S. constitution.

Impact on employer plans pending: Judge O’Conner’s decision “reserves ruling on the appropriate remedy” and has asked both parties to file briefs on the scope of relief the court should apply, which could include striking down the coverage mandate.

Employer spending on ACA-mandated preventive services is 2% to 3.5% of total annual expenditures by private employer health plans, or about $100 to $200 per person, according to the Health Care Cost Institute.