Preventive care issues are faced by employers who must make decisions about employee benefits. The issue has become cloudy lately. The court ruling update about preventative care services gives an explanation of what’s going on now with the preventive services offered by healthcare plans. This is an ongoing issue. We’ll keep you informed as things develop. Here’s how things stand now.
The lasted ruling:
- In March of last year, a Texas court declared a crucial component of the Affordable Care Act, which mandated health plans to cover preventive care without any cost to patients, as unconstitutional. However, the Fifth Circuit Court of Appeals temporarily suspended this ruling last month, reinstating the provision of the health law. Additionally, the court requested the parties involved to explore the possibility of reaching a compromise regarding the extent to which the mandate should be put on hold while it deliberated on its decision.
Recently, lawyers reached an agreement that largely preserves the provision, thereby compelling the majority of health plans to continue offering preventive care at no expense. Nevertheless, an exception has been made for the small businesses and individuals who challenged the provision. They are now permitted to choose a plan that does not cover all preventive services if they can find a health insurer that provides such an option.
The Texas court ruling was rooted in the argument that an independent panel, responsible for advising the government on covered benefits, lacked the proper authority to do so. However, this ruling solely pertained to services recommended for inclusion after 2010, namely screenings for child anxiety, unhealthy drug use, weight gain in pregnant women, and the suggestion that individuals at high risk for H.I.V. take PrEP—a daily pill highly effective in preventing the transmission of the virus. The reasoning behind this exclusion was the concern that these recommendations might promote homosexual activity or intravenous drug use.
The appellate court is anticipated to render a decision on the constitutionality of this mandate later this year and must still approve the agreement reached by the lawyers.
To get your questions answered by this RRC member expert Patti Goldfarb, click here.
[1] www.irs.gov/individuals/frequebntly-asked-questions-about-medical-expenses-related -to-nutrition-wellness-and-general-health