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.

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.