Republican-Appointed Judge Strikes Down Affordable Care Act Coverage of Many Preventative Services: ‘A Huge Blow to Americans’ Health’

A supporter of the Affordable Care Act in front of the Supreme Court on Nov. 10, 2020 in Washington, D.C. (Samuel Corum / Getty Images)

A federal district court judge in Texas issued a ruling on Thursday blocking certain Affordable Care Act (ACA) requirements that insurers cover preventative care services with no out-of-pocket costs. The ruling applies nationwide.

“Today’s decision is dangerous, deadly, and could deal a huge blow to Americans’ health,” said Rep. Lois Frankel (D-Fla.), chair of the Democratic Women’s Caucus “This backwards ruling threatens the ACA’s preventative care protections that directly improved women’s health and could end insurance coverage for critical care like PrEP and cancer screenings.”

The judge’s decision means millions of people could lose access to over 60 essential preventive services aimed at early detection of diseases, including breast and cervical cancer screenings, as well as breastfeeding support and pregnancy-related preventative care, including screenings for postpartum depression, preeclampsia and gestational diabetes. Research has shown that the ACA cost-free coverage of preventative services led to more people using them and narrowed care disparities in communities of color.

The lawsuit was filed by Texas attorney Jonathan F. Mitchell, who is credited with devising the Texas bounty hunter law SB 8.

The judge, Reed Charles O’Connor, is a 57-year old Republican appointed by George W. Bush in 2007. In 2018, O’Connor ruled that the ACA was unconstitutional—a ruling later reversed on appeal.

“This decision allows employers to deny coverage of lifesaving medication, taking health care decisions away from patients. That’s just outrageous,” said Frankel. “It should be up to you and your doctor to decide what health care you should receive—not your employer, a politician or a judge in Texas.”

The decision will impact more than 150 million Americans with private insurance who have been able to access preventive services without cost-sharing.

“Reimposing cost sharing on these services will significantly reduce patients’ ability to access them, and this burden will disproportionately fall on low-income patients, patients of color, and women and other patients who can become pregnant,” said Century Foundation Fellow and healthcare expert Thomas Waldrop.

The Justice Department is likely to appeal the decision, but Texas is in the Fifth Circuit Court of Appeals, one of the most conservative federal circuit courts in the country.

O’Connor did not strike down the ACA’s contraceptive mandate, but that issue could be reopened on appeal.

Demonstrators protest during the Senate Judiciary Committee confirmation hearing for Supreme Court justice nominee Amy Coney Barrett on Oct. 14, 2020. (Tom Williams / CQ-Roll Call, Inc via Getty Images)

U.S. Senator Patty Murray (D-Wash.) condemned the decision. “This is a downright dangerous decision that, if left to stand, will deny patients in every part of our country the ability to get the basic health care services they count on.”

The Affordable Care Act requires private health insurance plans to cover in-network preventive services at no cost to patients, including all preventive services recommended by the U.S. Preventive Services Task Force with an “A” or “B” rating. A full list of those preventive services—which are implicated by the ruling today—is available here.

“More than a decade after we passed the ACA, Republican interests are still working around the clock to roll back critical protections for patients—and this decision is just the latest in their slew of attacks on Americans’ ability to simply get the health care they need,” said Murray.

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Carrie N. Baker, J.D., Ph.D., is the Sylvia Dlugasch Bauman professor of American Studies and the chair of the Program for the Study of Women and Gender at Smith College. She is a contributing editor at Ms. magazine. You can contact Dr. Baker at or follow her on Twitter @CarrieNBaker.