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Bulletproofing the ACA’s Preventive Services Provision

By Andrew Umipeg

What would it look like if more than 2/3s of Americans were unable to access vital healthcare services and treatments because of financial, racial, or other systematic discrimination?  Due to the ruling in Braidwood Management v. Becerra, this nightmare is one step closer to becoming a reality for many underprivileged Americans across the nation, as a result of encroachments on the ACA and its preventive services provision.  

In 2010, policymakers came together to forge the Affordable Care Act (ACA), commonly known as Obamacare, predicated on making affordable health insurance more accessible to all Americans via “consumer subsidies,… [expansion of] the Medicaid program,… [and] innovative medical care delivery methods [1].”  One of the major tenets of the ACA is a requirement barring health plans from refusing to cover preventive services such as early cancer screenings, mental health assessments, and Pre-exposure prophylaxis (PreP) to prevent HIV [2].  This requirement is known as the preventive services provision of the ACA and is heavily relied upon by over 224 million Americans nationwide to make access to these services attainable.  However, in light of a recent ruling in Braidwood Management v. Becerra, the preventive services provision of the ACA is under heavy siege and severe risk of being phased out by private healthcare providers.  

On March 30, 2023, a Texan federal district court made a ruling in Braidwood Management v. Becerra which “[struck] down any services recommended by the U.S. Preventive Services Task Force (USPSTF),” citing that the ACA’s preventive services provision was unconstitutional since the three expert bodies in charge of determining which services should be covered are not constitutionally appointed [2].  In other words, a singular Texan judge applied an incredibly strict constructionist approach in interpreting the Constitution, on a remarkably ambiguous topic, in order to strike down critical healthcare services for millions of Americans across the nation.  This ruling primarily affects Americans with private health insurance, which according to the US Census Bureau in 2021, comprised 66.0% of Americans [3]. 

The ruling in Braidwood v. Becerra is a gross indiscretion on the part of Judge Reed O’Connor, who presided over the ruling and who has a long history of opposing Democratic policies.  Over his judicial career, Judge O’Connor has created quite the reputation for himself as a strongly conservative-leaning judge, making him “the federal judge that Republican state attorneys general and politically conservative special interest groups across the U.S. turn to when they want a federal law or policy overturned or banned [4].” 

The dastardly and starkly partisan overstep of judicial power by Judge O’Connor in the Becerra case is a scathing reflection of a major pitfall within the American Judiciary system.  The role of the courts is to uphold the law and the accountability of policymakers when they institute legislation, not to play fixer when one party wishes to undermine legislation set forth by their opponents, based primarily on ideological opposition with marginal gain to be had at its overturn.  This is particularly pertinent in a landmark case such as Braidwood v. Becerra where the overturning of legislation would be deleterious to the health and well being of the nation’s citizens.  The despicable ruling in the Becerra case is a grave disservice not only to the millions of disadvantaged Americans that rely upon the ACA’s preventive services provision, but to the integrity of the American Judicial system more broadly.  Ruling against the ACA preventive services provision raises the risk of Americans neglecting preventive services, consequently increasing the risk of individuals succumbing to the early-onset of cancer, exacerbation of mental health disorders, and much more [2].  The Becerra case highlights the dire need to prevent the courts from being weaponized for political gain, especially to the detriment of public health.  

Luckily, for those in favor of the preventive services provision of the ACA, there is still action we can take to ensure that these imperative healthcare services are not lost forever.  While the appeal to the Becerra ruling is processed, we as champions of the underprivileged must come together to lobby the United States Department of Justice (DOJ) to request the court to “stay” the decision, effectively preventing the decision from going into effect while the decision is ruled on by an appellate court.  In addition, further lobbying, through amicus curiae briefs, must be directed to the Texas Court of Appeals charged with ruling on the decision to argue for the rescinding of this decision and the protection of health coverage for over 2/3s of the American population.  We must come together to garner a successful appeal that preserves the ACA preventive services provision, ensuring improved health outcomes for all Americans and abating systematic discrimination in accessing healthcare.  

Works Cited

  1.  “Affordable Care Act (ACA).” Accessed April 23, 2023.
  2. Corlette, Sabrina. “A World without the ACA’s Preventive Services Protections: The Impact …” Health Affairs, April 11, 2023.
  3. Keisler-Starkey, Katherine, and Lisa N. Bunch. “Health Insurance Coverage in the United States: 2021.”, November 15, 2022. 
  4. Staff Writer. “Texas Judge Reed O’Connor Is the ‘Go-to Judge’ for Conservatives.” AP NEWS. Associated Press, December 21, 2018. 

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