Public health advocates swiftly condemned a sweeping Texas court ruling this week that endangers access to preventive health services for millions of Americans.

On Thursday, a federal district court judge overturned a requirement that health insurance plans fully cover preventive services recommended by the U.S. Preventive Services Task Force. The requirement is an essential part of the Affordable Care Act and has allowed Americans to access services such as cancer screenings, tobacco cessation services, immunizations, childhood lead screening and more without cost sharing for more than a decade.

The court decision “threatens the health of all Americans,” according to APHA.

“We, as a nation, cannot let this stand; we will all suffer," APHA Executive Director Georges Benjamin, MD, said in a statement. “We urge the Biden administration to appeal the ruling and hope that the judge or a higher court will issue a stay while it goes through the appeal process. In the meantime, we strongly encourage everyone to take advantage of the care still available to them today and to let their employer and public officials know that they demand preventive care.” 

The lawsuit, Braidwood Management Inc v. Xavier Becerra, was led by a Texas hospitality company, which said that providing coverage for medications such as PrEP, which is used to prevent HIV infection, violated religious beliefs. The case was argued before U.S. District Court Judge Reed O’Connor — the same judge who ruled to overturn the Affordable Care Act four years ago. That case made its way to the U.S. Supreme Court, which upheld the ACA. 

“An individual's personal belief does not change the fact that HIV prevention helps people live healthy lives,” the American College of Obstetricians and Gynecologists said in a statement. “We should be working toward increased access to and utilization of all preventive care recommended by the U.S. Preventive Services Task Force. Instead, we find ourselves once again defending health care from outside interference and responding to attempts to dismantle our current preventive care system.”

The Biden administration is expected to appeal the ruling and request a stay. 

What they said: A sampling of statements from public health supporters

“As our public health systems have buckled under the strain of rising disease rates and falling funding, we have grown increasingly reliant on the routine, privately funded health services that most people use to access services like standard syphilis testing during routine prenatal care or HIV tests in our yearly check-ups. This ruling rips out the backbone of the U.S. health care system, and risks the future health of every single American.”  
— David Harvey, executive director, National Coalition of STD Directors 

“This decision is as infuriating as it is harmful. Preventative health care covered by insurance is essential and has helped people live healthier, longer lives. Now, because of one federal judge in Texas, the millions of people who benefit from vital health care like PrEP, cancer screenings and more may be stripped of their ability to access the health care they need.”  
— Alexis McGill Johnson, president and CEO, Planned Parenthood Federation of America

“Fewer people will get prenatal care and preventive screenings, fewer cancers will be detected early when they are more treatable, fewer mental health problems will be identified and treated, fewer people will get immunizations and treatment for sexually transmitted diseases, and many more people in the U.S. will suffer and die. Low-income communities and communities of color will suffer the most as health care costs rise, putting life-saving preventive care out of reach for millions.”
— Kristin Rowe-Finkbeiner, executive director and CEO, MomsRising

“We cannot risk returning to a system wherein every individual has to decipher whether their insurance plan covers a recommended preventive measure, and if so, what their out-of-pocket costs may be and whether they can afford it. The confusion and uncertainty will no doubt be a deterrent to early and effective life-saving interventions.”
— joint statement from American Cancer Society Cancer Action Network, American Lung Association and 14 others that submitted a friend-of-the-court brief in the lawsuit

“Preventive health services save lives. This decision limits the availability of proactive care procedures that reduce unnecessary pain, suffering and death, along with being more cost-effective…This decision will disproportionately impact low-income and historically marginalized communities, as they are least able to afford preventive care and often at high risk of developing preventable medical conditions.”
— Georges Benjamin, MD, executive director, American Public Health Association

“Providing insurance coverage for screenings and interventions that prevent disease saves lives — period. The burden of losing this first-dollar coverage will fall disproportionately on low-income and historically marginalized communities that are least able to afford it and are often at high risk of developing preventable medical conditions. Denying access to proven preventive care flies in the face of good policy, and the societal costs of establishing barriers to preventive services are immeasurable.” 
— Jack Resneck Jr., MD, president, American Medical Association         

The ruling “is a major setback to ending HIV as an epidemic and for improving the health of Americans by preventing the spread of other infectious diseases in the United States. The ACA’s preventive services benefit removed financial barriers to screening tests and improved access to highly effective interventions like HIV pre-exposure prophylaxis. It saved lives and controlled the transmission of infections.”
— Carlos del Rio, MD, FIDSA, president, Infectious Diseases Society of America; and Michelle Cespedes, MD, MS, chair, HIV Medicine Association

“This is a downright dangerous decision that, if left to stand, will deny patients in every part of our country the ability to get the basic health care services they count on — we’re talking about everything from cancer and cholesterol screenings to STI testing, HIV prevention drugs and more. it will particularly hurt patients with the tightest budgets, as well as LGBTQ+ patients who count on medications like PrEP to keep them healthy and safe. This decision should enrage every American.”
— Sen. Patty Murray, D-Wash.

“This decision, if implemented, would erode access to an entire range of preventive health services — from cancer screening to HIV prevention to preeclampsia screening for expecting mothers. Families deserve better than having bedrock protections of the health reform law invalidated with a two-page ruling.”
— Margaret Murray, CEO, Association for Community Affiliated Plans

Caption: People rally in support of the Affordable Care Act at the White House in 2017. (Photo by Ted Eytan via Flickr Creative Commons)