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In a big blow to health insurance in the U.S., a federal judge has ruled that insurers no longer have to pay for preventive care services like cancer and heart disease screenings.
The ruling comes as a result of a lawsuit brought by a group of insurers who argued that the Affordable Care Act (ACA) exceeded its authority by requiring them to cover certain preventative care services without being able to charge copayments or deductibles.
The Affordable Care Act, or Obamacare, was signed into law in 2010 to make it easier for millions of Americans to get health insurance.
One of the law’s key provisions was the requirement that insurance companies cover certain preventative care services without cost-sharing, including immunizations, blood pressure screenings and mammograms.
However, the recent ruling by U.S. District Judge Reed O’Connor, of the Northern District of Texas, has effectively invalidated this provision of the ACA.
In his ruling, Judge O’Connor wrote that the ACA’s requirement for insurers to cover preventative care services “exceeds the powers of Congress under the Commerce Clause” of the U.S. Constitution.
The ruling is likely to significantly affect health insurance in the U.S., especially for people who already have health problems like cancer or heart disease.
If insurance companies weren’t required to cover preventive care services, patients might be less likely to get the screenings and tests that could catch these health problems early.
Experts said this could lead to serious health problems and higher health care costs.
“The President is glad to see the Department of Justice is appealing the judge’s decision, which blocks a key provision of the Affordable Care Act that has ensured free access to preventive health care for 150 million Americans,” White House press secretary Karine Jean-Pierre stated.
“This case is yet another attack on the Affordable Care Act – which has been the law of the land for 13 years and survived three challenges before the Supreme Court,” Jean-Pierre continued. “Preventive care saves lives, saves families money, and protects and improves our health. Because of the ACA, millions of Americans have access to free cancer and heart disease screenings. This decision threatens to jeopardize critical care.
“The administration will continue to fight to improve health care and make it more affordable for hard-working families, even in the face of attacks from special interests,” she said.
Critics of the ruling include health care advocacy groups and politicians. They say it will make it more complicated and expensive for millions of Americans to get health insurance. In a statement, Dr. Patrice Harris, president of the American Medical Association, called the ruling “a clear step backward for our health system.”
“Preventative care is a cornerstone of good health,” Dr. Harris said. “It’s critical that patients have access to these services without cost-sharing to stay healthy and catch health problems early before they become more serious and more costly to treat.”
The ruling is also likely to face legal challenges in the coming months. Several states and health care advocacy groups have already said they will appeal the decision. They say that the ACA’s requirement that insurers cover preventive care services is a crucial part of the law’s goal to make more people eligible for health insurance.
In the meantime, patients and health care providers alike are left to grapple with the uncertain future of health care coverage in the U.S. Without the assurance of coverage for preventative care services, and patients may be forced to choose between paying out-of-pocket for these services or foregoing them altogether, potentially putting their health and well-being at risk.
“Once again, an extreme activist judge is taking a monumental swing at the Affordable Care Act, which has saved millions of lives and made Americans healthier for the last 13 years,” Congressional Black Caucus Chair Steven Horsford (D-Nevada) stated.
“The preventative care provisions in the law have ensured that, without concern for cost, Americans have been able to get screened for things like diabetes, breast cancer and heart disease. “It also puts the brakes on critical preventative treatments like immunizations and PrEP for HIV.
“The impact of this ruling, especially on working Nevadans and communities of color, will result in the loss of lives, increased costs for treatment of preventable illnesses, and increased inequities in our already unbalanced health care system.”