August ACA Compliance Update

The 5th U.S. Circuit Court of Appeals recently ruled that a key component of the Affordable Care Act’s (ACA) preventive care mandate is unconstitutional. However, in a decision it referred to as a “mixed bag,” the 5th Circuit limited its ruling to the plaintiffs in the case, a small group of individuals and businesses from Texas.

 

The ACA requires non-grandfathered health plans and issuers to cover a set of recommended preventive services without imposing cost-sharing requirements, such as deductibles, copayments or coinsurance, when the services are provided by in-network providers.

 

 

In March 2023, the U.S. District Court for the Northern District of Texas struck down a key component of the ACA’s preventive care mandate as unconstitutional and issued a nationwide injunction against its enforcement. This decision involved a wide range of preventive care services, such as cancer screenings and medications for chronic diseases. The 5th Circuit put the District Court’s decision on hold pending its ruling, which means health plans and issuers have been required to fully comply with the ACA’s preventive care mandate without interruption.

 

 

Health plans and issuers must continue to cover the full range of recommended preventive care items and services without cost sharing. Only the plaintiffs in the case are exempt from a portion of the ACA’s preventive care mandate. However, the future of the ACA’s free preventive care mandate remains uncertain. Employers should continue to watch for developments on this issue, as it is likely that the 5th Circuit’s decision will be appealed to the U.S. Supreme Court.