A federal appeals court held a brief hearing Tuesday afternoon to hear from attorneys on both sides as it decides whether to lift a nationwide freeze on a lower court's ruling that struck down preventive care protections in the Affordable Care Act (ACA).
A panel of judges at the Fifth Circuit Court of Appeals, based in New Orleans, issued a stay on the District Court ruling while the appeals process plays out, though it could choose to lift the stay following Tuesday's hearing. Legal experts expect a decision on the pause in short order.
The lower court decision in question blocked the federal government from enforcing preventive care mandates backed by the U.S. Preventive Services Task Force (PSTF) and rendered previous decisions from the group unconstitutional. Texas Judge Reed O'Connor took issue with how PSTF members are nominated in the ruling.
The lawsuit was brought by several individuals as well as one business, Braidwood Management, which also argued that providing coverage for pre-exposure prophylaxis drugs that prevent HIV infections violated their religious freedoms.
A central question during the hearing was whether the individual plaintiffs have the standing to challenge the broader preventive services mandate, and judges appeared skeptical as to whether these individuals would purchase insurance coverage even if the mandate was removed. Jonathan Mitchell, attorney for the plaintiffs and former solicitor general of Texas, argued that if Braidwood, as a self-insured company, had the standing to seek a remedy in this case, the individuals would likewise.
"They may still be able to freeride or piggyback on Braidwood's standing," he said.
Alisa Beth Klein, arguing on behalf of the Department of Justice, said that the federal government does not necessarily object to individual relief for the plaintiffs, but takes issue with the remedy for their concerns extending to millions of people across the country. Should the ruling be upheld, it would have impacts on coverage for 150 million people nationwide, she said.
"It's very important to the people insured under those plans" that they continue to have access to the no-cost preventive care services. While PrEP is central to the legal debate, Klein noted that O'Connor's ruling would extend to approximately 50 preventive screenings, including some for cancer and behavioral health.
"There has to be a consideration of the balance of equities in the public interest," she said.
Healthcare industry groups have roundly criticized O'Connor's decision. In an amicus curiae brief filed with the circuit court, the American Medical Association and a slew of other physician organizations argued that without a stay pending appeal, the ruling could "reverse positive trends in patient health achieved by the early detection and treatment of diseases and other medical conditions."
"As professional organizations representing physicians across the country, Proposed Amici know the value of preventive care services, such as colonoscopies and mammograms, in helping their patients to live long, healthy lives," the groups wrote in the brief.
Much like similar challenges to the ACA, the ruling is expected to have a long legal road ahead of it that likely ends before the Supreme Court.