Skip to content Skip to search

Republish This Story

* Please read before republishing *

We’re happy to make this story available to republish for free under an Attribution-NonCommercial-NoDerivatives Creative Commons license as long as you follow our republishing guidelines, which require that you credit The 19th and retain our pixel. See our full guidelines for more information.

To republish, simply copy the HTML at right, which includes our tracking pixel, all paragraph styles and hyperlinks, the author byline and credit to The 19th. Have questions? Please email [email protected].

— The Editors

Loading...

Modal Gallery

/
Sign up for our newsletter

Menu

  • Our Mission
  • Our Team
  • Latest Stories
  • Search
  • Upcoming Events
  • Contact Us
  • Newsletter
  • Donate
  • Work With Us
  • Fellowships
    • From the Collection

      Changing Child Care

      Illustration of a woman feeding a baby a bottle
      • Washington, D.C., offers financial relief to local child care workers

        Orion Rummler · September 20
      • As climate change worsens hurricane season in Louisiana, doulas are ensuring parents can safely feed their babies

        Jessica Kutz · May 5
      • Supreme Court Justice Samuel Alito argued abortion isn’t an economic issue. But is that true?

        Chabeli Carrazana · May 4
    • From the Collection

      Next-Gen GOP

      Illustration of a woman riding an elephant
      • Mayra Flores’ victory set a record for women in Congress. It also reflects the growing visibility of Republican Latinas

        Candice Norwood · June 21
      • A banner year for Republican women

        Amanda Becker · November 11
      • Republican women could double representation in the U.S. House

        Amanda Becker · November 4
    • From the Collection

      On The Rise

      Illustration of three women marching
      • Can Cheri Beasley build a winning coalition in North Carolina?

        Candice Norwood · October 11
      • Los Angeles has never elected a woman mayor. Karen Bass hopes to change that.

        Nadra Nittle · September 8
      • Judge J. Michelle Childs is confirmed to D.C. appeals court

        Candice Norwood · July 20
    • From the Collection

      Pandemic Within a Pandemic

      Illustration of four people marching for Black Lives Matter with coronavirus as the backdrop
      • The 19th Explains: Why the nursing shortage isn’t going away anytime soon

        Mariel Padilla · September 23
      • Some LGBTQ+ people worry that the COVID-19 vaccine will affect HIV medication. It won’t.

        Orion Rummler · November 23
      • Why are more men dying from COVID? It’s a complicated story of nature vs. nurture, researchers say

        Mariel Padilla · September 22
    • From the Collection

      Portraits of a Pandemic

      Illustration of a woman wearing a mask and holding up the coronavirus
      • For family caregivers, COVID is a mental health crisis in the making

        Shefali Luthra · October 8
      • A new database tracks COVID-19’s effects on sex and gender

        Shefali Luthra · September 15
      • Pregnant in a pandemic: The 'perfect storm for a crisis'

        Shefali Luthra · August 25
    • From the Collection

      The 19th Explains

      People walking from many articles to one article where they can get the context they need on an issue.
      • The 19th Explains: What we know about Brittney Griner’s case and what it took to get her home

        Candice Norwood, Katherine Gilyard · December 8
      • The 19th Explains: Why the Respect for Marriage Act doesn’t codify same-sex marriage rights

        Kate Sosin · December 8
      • The 19th Explains: Why baby formula is still hard to find months after the shortage

        Mariel Padilla · December 1
    • From the Collection

      The Electability Myth

      Illustration of three women speaking at podiums
      • Mayra Flores’ victory set a record for women in Congress. It also reflects the growing visibility of Republican Latinas

        Candice Norwood · June 21
      • Stepping in after tragedy: How political wives became widow lawmakers

        Mariel Padilla · May 24
      • Do term limits help women candidates? New York could be a new testing ground

        Barbara Rodriguez · January 11
    • From the Collection

      The Impact of Aging

      A number of older people walking down a path of information.
      • From ballroom dancing to bloodshed, the older AAPI community grapples with gun control

        Nadra Nittle, Mariel Padilla · January 27
      • 'I'm planning on working until the day I die': Older women voters are worried about the future

        Mariel Padilla · June 3
      • Climate change is forcing care workers to act as first responders

        Jessica Kutz · May 31
    • From the Collection

      Voting Rights

      A series of hands reaching for ballots.
      • Election workers believe in our system — and want everyone else to, too

        Barbara Rodriguez, Jennifer Gerson · November 8
      • Voter ID laws stand between transgender people, women and the ballot box

        Barbara Rodriguez · October 14
      • Emily’s List expands focus on diverse candidates and voting rights ahead of midterm elections

        Errin Haines · August 30

    View all collections

  • Explore by Topic

    • 19th Polling
    • Abortion
    • Business & Economy
    • Caregiving
    • Coronavirus
    • Education
    • Election 2020
    • Election 2022
    • Environment & Climate
    • Health
    • Immigration
    • Inside The 19th
    • Justice
    • LGBTQ+
    • Politics
    • Press Release
    • Race
    • Sports
    • Technology

    View All Topics

Home
  • Our Mission
  • Our Team
  • Latest Stories
  • Search
  • Upcoming Events
  • Contact Us
  • Newsletter
  • Donate
  • Work With Us
  • Fellowships

We’re an independent, nonprofit newsroom reporting on gender, politics and policy. Read our story.

The 19th News(letter)

News from reporters who represent you and your communities.

You have been subscribed!

Submitting...

Uh-oh! Something went wrong. Please try again later.

Become a member

The 19th thanks our sponsors. Become one.

wall-mounted medical diagnostic equipment beside standard patient examination chair
(Getty Images)

Health

The Affordable Care Act’s biggest gender-based protections are under threat

The Texas-based case examines the ACA’s guarantee that preventive medicine be fully covered. It could affect coverage of PrEP, breastfeeding counseling, STI screening and contraception.

Shefali Luthra

Health Reporter

Shefali Luthra portrait

Published

2022-09-14 11:52
11:52
September 14, 2022
am

Share

  • Twitter
  • Facebook
  • Email

After a federal court decided that HIV prevention medication does not need to be covered under the Affordable Care Act, experts fear that many other reproductive health services — screening for sexually transmitted infections, breastfeeding counseling and even contraceptive care — could now be threatened. 

The ruling’s scope — including the nuances of how it could affect people’s insurance plans — will be addressed at a hearing Friday. If upheld, the case could ultimately reverse one of the most significant reforms established by the ACA, with particular impact on the law’s gender-based health protections.

“It would be devastating,” said Katie Keith, a health law expert at Georgetown University.

The 19th thanks our sponsors. Become one.

The decision, which was issued last week by a district judge in Texas, has not yet taken any effect or changed anyone’s insurance. At the hearing Friday, Judge Reed O’Connor will ask both sides to provide arguments for how his ruling should be enforced and discuss whether insurance must continue to fully cover contraception.

The case concerns an ACA provision requiring health insurance to cover certain preventive medical services with no out-of-pocket costs. Those benefits are picked by three federal bodies: the U.S. Preventive Services Task Force, the Health Resources and Services Administration, and the Advisory Council on Immunization Practices. Benefits include a daily pill taken for HIV prevention — known as pre-exposure prophylaxis (PrEP), which is 99 percent effective — as well as at least one version of each method of contraception. 

The plaintiffs, a group of employers, argued that the U.S. Constitution does not allow the government to let those three bodies determine which medical services are covered. They also argued that they should not have to provide insurance covering PrEP and contraception, because doing so violated their religious beliefs.

Stories by experienced reporters you can trust and relate to.

Delivered directly to your inbox every weekday.

You have been subscribed!

Submitting…

Uh-oh! Something went wrong. Please try again later.

Last week, O’Connor, who has previously issued decisions that would weaken the ACA, ruled partially in favor of the plaintiffs. 

In his decision, he struck down the requirement that insurance cover, without cost-sharing, the benefits that are recommended by the U.S. Preventive Services Task Force. Those include HIV screening, chlamydia and gonorrhea screenings, breastfeeding support, mental health interventions for pregnant and postpartum people, and extra counseling and treatment for people at higher risk of breast cancer. The ruling did not address contraceptive benefits, which are not determined by the Preventive Services Task Force 

Separately, O’Connor also ruled that the plaintiffs should not be required to cover PrEP if they felt that doing so violated their religious beliefs. 

Neither the impact of the ruling nor its timing is clear. Following Friday’s briefing, O’Connor could limit his ruling only to affect the plaintiffs so that only they, and anyone else who files similar lawsuits, would be exempt from the ACA requirements. He could issue a nationwide injunction, blocking the affected ACA requirements for health plans more broadly. 

“It’s a question of the scope,” said Laurie Sobel, associate director of women’s health policy at the nonpartisan Kaiser Family Foundation. “In the past, Reed O’Connor has not been shy about issuing national injunctions.”

It is not clear how long after Friday’s hearing O’Connor will issue a decision, or what the next steps might be. The list of benefits that could be affected is extensive.

“Are you really going to drop depression services? Screening for pregnancy and diabetes?” Sobel said.

In his ruling last week, O’Connor did not address litigants’ religious objections to covering contraception, instructing them to address that at Friday’s briefing. That means O’Connor could issue a decision weakening that protection, potentially striking down entirely the ACA requirement that birth control be covered with no cost-sharing. 

  • Read Next:
    The U.S. Capitol Dome in Washington, D.C.
  • Read Next: Democrats urge Biden administration to use HIPAA to protect abortion rights and privacy

The Supreme Court has already issued rulings that severely weakened the contraceptive mandate, allowing employers with religious and moral objections to opt out of providing that benefit. 

Because health insurance plans are already being set for next year, and because it’s not yet clear what policy O’Connor will order, the case will not immediately change anyone’s health insurance. If O’Connor issues an injunction, the federal government is also likely to appeal the case, which would first go to the U.S. Court of Appeals for the 5th Circuit — considered the most conservative appeals court in the country — and then to the Supreme Court. 

The Supreme Court, which has shifted to the right, may also be more willing than it was a few years ago to issue a ruling that significantly weakens the preventive services coverage mandate. A decision could come this fall through the high court’s so-called “shadow docket,” Sobel said. That refers to a process in which the court issues often-major decisions outside the timeline and scrutiny of the normal Supreme Court calendar.

If that happened, health insurance plans could try to change their benefits before 2023, but the larger impact would likely emerge the following year. It’s difficult to know what benefits plans might drop if they are no longer required to offer them. But the impact could be significant.

“You’re going back to the pre-ACA world,” Keith said. The preventive services mandate “is one of the most popular and widely recognized benefits of the ACA. It’s been 12 years that it’s been in place. It’s maybe not the heart of the ACA, but it’s a pretty core and highly visible part.”

Share

  • Twitter
  • Facebook
  • Email

Help sustain what we started

Your monthly investment is critical to our sustainability as a nonprofit newsroom.

Donate Today

Become a member

Up Next

The U.S. Capitol Dome in Washington, D.C.

Abortion

Democrats urge Biden administration to use HIPAA to protect abortion rights and privacy

In a letter first shared with The 19th, 30 senators wrote to the health and human services secretary urging him to take action.

Read the Story

The 19th
The 19th is a 501(c)(3) tax-exempt organization. Our stories are free to republish in accordance with these guidelines.

  • Donate
  • Newsletter
  • Events
  • Search
  • Jobs
  • Fellowships
  • Contact Us
  • About Us
  • Community Guidelines
  • Membership
  • Membership FAQ
  • Major Gifts
  • Sponsorship
  • Privacy
  • Twitter
  • Facebook
  • Instagram