A federal appeals court ruled on Friday that a Christian-owned business can't be compelled to cover preventive medications as is required under the Affordable Care Act (ACA), but determined a Texas judge had carried out an "abuse of discretion" in his prior ruling by blocking federal agencies from enforcing the rule universally.
In a decision that it characterized as a "mixed bag," the U.S. Fifth Circuit Court of Appeals affirmed a lower court's ruling that the secretary of the Department of Health and Human Services (HHS) could not force Braidwood Management, Inc. to abide by a preventive care mandate in the ACA. The court rejected another ruling, however, and remanded another one back to the lower courts.
The ACA provision in question requires private health insurers and companies to cover preventive services and drugs like HIV preventive drugs, known as PrEP, which Braidwood objected to. This provision also requires coverage of cancer screenings, vaccines, STD screenings, gestational health screenings and birth control.
The company claimed this requirement was a violation of its religious freedom as a Christian company because it made them “complicit in facilitating homosexual behavior, drug use, and sexual activity outside of marriage between one man and one woman."
Judge Reed O’Connor, a George W. Bush appointee for the U.S. District Court for the Northern District of Texas, struck down the provision in September 2022. The appeals court said in the Friday ruling that it believed blocking the federal government from enforcing this mandate across the board was an "error" and "an abuse of discretion."
"It follows, in our view, that there was also no basis for the universal injunction," the court wrote in its ruling.
The court determined other arguments had yet to be fully decided and should be subject to further review in the lower courts.
One of the key questions left to be answered was whether the U.S. Preventive Task Force that decides which services must be covered under the ACA is constitutionally sound. O'Connor had ruled that the task force's system was unconstitutional.
The plaintiffs argue that the task force violates the Appointments Clause of the U.S. Constitution because Task Force members are not nominated by the president or confirmed by the Senate. The federal government has argued that the task force members are private citizens who don't qualify as principal officers of the U.S.
The court found that HHS Secretary Xavier Becerra had not "cured" the constitutional problems lingering over the Task Force but declined to issue a ruling on this particular question.
"We are disinclined to decide questions without sufficient briefing, particularly ones of high stakes and of constitutional import. We also generally prefer to adhere to our policy of being 'a court of review, not first view,'" they wrote.
Like the court's ruling, stakeholders had mixed reactions to the news on Friday.
"While we were predicting the worst, at the moment insurers will still have to cover preventive services, including PrEP, except for the original plaintiffs. That is the good news," Carl Schmid, executive director of the HIV + Hepatitis Policy Institute, said in a statement.
"The bad news is, the court still finds the mandate to cover USPSTF recommended services unconstitutional and now asks the lower court to review both the HRSA and ACIP preventive services." Schmid added. "The case is not going to the Supreme Court at this time, but back to the lower court. Coverage of preventive services continues."
“While we had hoped for a complete reversal of the District Court’s ruling, this decision is a sigh of relief for the 151 million people – including 37 million children – whose access to free preventive services has been hanging in the balance for over a year,” said Natalie Davis, United States of Care CEO and co-founder.
