A federal district court judge in Texas has gutted a core healthcare protection that Americans have enjoyed for more than a decade: a government mandate guaranteeing cost-free preventative services. Under the ruling, cancer screenings, pre-exposure prophylaxis (PrEP) for preventing HIV, and care for pregnant people may soon become a lot more expensive. The Biden administration will appeal the decision—but there’s no guarantee that higher courts, packed with far-right appointees, will overturn today’s ruling.
One of the critical benefits in President Barack Obama’s Affordable Care Act was the guarantee that insurance would cover preventative care free of charge—no copay, no deductibles. This preventative care mandate made it much more likely that people who are struggling financially can access essential care to preserve their health and catch diseases early.
But Judge Reed O’Connor, a George W. Bush appointee, ruled Thursday that the preventative care mandate is unconstitutional. Under the decision, the list of services that could become out of reach for many people is long, and, aside from the latest recommendations on life-saving cancer screenings, HIV prevention, and prenatal care, also includes physical therapy for the elderly, Type 2 diabetes screening, smoking cessation, childhood vision tests, among other medical interventions.
His opinion finds that the task force that decides which services and medications fall under the preventative care requirement violates the Constitution. He also found that employers have a religious right to deny their employees coverage of PrEP if it violates their religious beliefs. In this case, plaintiff and GOP megadonor Steven Hotze wants to deny his employees the drugs because he believes that protecting them from HIV encourages sexual interactions he doesn’t like. Several other plaintiffs are individuals who want to purchase insurance that does not cover contraception or PrEP drugs.
O’Connor is a go-to judge for conservatives trying to undo Democratic policies, and this is not the first time he has tried to weaken Obamacare. In 2018, he ruled the entire law unconstitutional in an opinion ridiculed for its tortured logic; the Supreme Court eventually overruled him. O’Connor has kneecapped other Democratic policies, including multiple rules to protect transgender people from discrimination, and ruled in favor of allowing sex discrimination on religious grounds.
Ending the preventative care requirement could impact millions of people. Major medical groups warned the court that it will lead to preventable deaths and higher costs. Stripping medical care from pregnant people is particularly dangerous in a post-Roe world where abortion is illegal in much of the country and medication abortion is imperiled. O’Connor’s ruling will make it harder for pregnant people to afford medical care—from screenings to medication to breastfeeding assistance to mental health care. (While O’Connor left Obamacare’s contraception coverage mandate standing, it remains vulnerable on appeal before the conservative Fifth Circuit.)
Lawyer Jonathan Mitchell, the architect of Texas’ bounty hunter-enforced abortion ban, brought this case. Mitchell also brought a case before O’Connor in which the judge green lit LGBTQ discrimination by private businesses, using the same plaintiff—the company owned by Hotze—in that case as in today’s Obamacare case. Mitchell also appears to have used a repeat plaintiff, Ashley Maxwell of Hood County, Texas, in the Obamacare case after using her in a case that sought to enforce his abortion ban. In both today’s case and his abortion ban case, Mitchell teamed up with America First Legal Foundation, a group run by former Trump administration adviser Stephen Miller.
The nexus illustrates the tactics the modern conservative legal project is using to accomplish its longstanding goals of stripping rights from disadvantaged communities and forcing pregnant people to give birth. By waging war on Obamacare, it is, at the same time, cruelly stripping away resources that help ensure pregnancies are healthy and affordable.