About 1 in 20 People with Private Insurance Received Services that Could be Affected by a District Court Ruling Limiting the ACA’s Preventive Services Mandate

A new KFF analysis finds about 1 in 20 privately insured people (5.7%) received at least one ACA preventive service or drug that could be affected by a now-stayed U.S. District Court ruling in Braidwood Management v. Becerra, which found the Affordable Care Act’s (ACA) preventive services mandate partially unconstitutional. The district court also found that pre-exposure prophylaxis (PrEP), medication recommended for HIV prevention, violates the religious rights of those who have objections to its use.

On Monday, May 15, the 5th Circuit Court of Appeals issued an administrative stay on the district court’s Braidwood ruling while they consider an appeal in the case. Major private health insurers have announced that they do not plan to make changes – if any were to be made at all – until after a final decision has been made.

The analysis uses 2019 claims data to examine the number of people who received preventive services that could be affected by the District Court’s ruling. It estimates that 10 million people received services that would no longer have to be covered without any cost sharing if the ruling is allowed to stand. Statins, which are used to treat people at risk of cardiovascular disease, are the most commonly used preventive service potentially affected.

The Texas District Court ruling applies only to preventive services recommended by the US Preventive Services Task Force (USPSTF) after 2010, when the ACA was enacted. As a result, the ruling could affect more services and people over time – as new drugs and treatments are developed, recommended, and adopted. For example, this analysis – which relies on 2019 claims data to reflect utilization in a typical pre-pandemic year – does not consider the ruling’s impact on more recent preventive service recommendations, like PrEP for HIV.

Among treatments approved in and before 2010, the ruling would not affect the costs of other common preventive services, such as vaccines recommended by the Advisory Committee on Immunization Practices (ACIP), women’s preventive health services (e.g. contraception and prenatal care), or mammography and cervical cancer screenings.

The federal government can continue enforcing the USPSTF’s entire preventive services requirement while the 5th Circuit considers the Department of Justice’s motion for a stay pending appeal.