Texas Judge Kills Preventive Health Screening For Millions
While trump’s indictment continues to suck the oxygen out of newsrooms everywhere, a federal court ruling of major concern has gone largely unnoticed and millions of Americans have lost insurance coverage to pay for life-saving, preventive health care.
The end of such vital health care came by way of an order of a federal judge in Texas, the same judge who once ruled that the Affordable Health Care Act or Obamacare was unconstitutional only to have his ruling reversed by the Supreme Court.
And meanwhile, the latest government report shows that people are dying sooner in Republican-dominated, so-called “Red” states where health care, especially preventive care, lags behind the longer living, healthier people in Democratic-majority or “Blue” states.
Last Thursday, U.S. District Judge Reed O’Connor in Fort Worth, Texas, ordered the federal government to stop requiring that insurance plans offer free preventive care, including screenings for certain cancers, screenings for adolescent depression and the use of pre-exposure prophylaxis (PrEP), a drug that has been shown effective in protecting people from getting HIV. Before O’Connor’s ruling, the Affordable Care Act required that PrEP along with the other screenings must be free under almost all health insurance plans.
The ruling took effect immediately and applies nationwide. O’Connor ruled that the advisory body that recommends what preventive care should be covered without cost, the Preventive Services Task Force, is illegal because its members are not directly appointed by the president, as required by the Constitution. The USPSTF is a group of independent disease prevention and medical experts whose recommendations help guide doctors’ decisions and national health policies.
O’Connor’s ruling means that insurers no longer have to provide free coverage for any care the USPSTF has recommended and been accepted by the federal government since 2010.
In addition to recommending coverage for PrEP, a daily pill that is highly effective at preventing the transmission of H.I.V., the USPSTF also has issued recommendations on interventions to prevent drug use in children, adolescents, and young adults; screening and behavioral counseling interventions for reducing unhealthy alcohol use in adolescents and adults; interventions for tobacco smoking cessation in adults, including pregnant people; and primary care interventions to prevent tobacco use in children and adolescents.
Regarding the health screenings, O’Connor ruled in favor of a lawsuit brought by eight people and two businesses, all from Texas, who argued that the free PrEP requirement requires business owners and consumers to pay for services that “encourage homosexual behavior, prostitution, sexual promiscuity and intravenous drug use” despite their religious beliefs.
The Justice Department announced on Friday that the government will appeal O’Connor’s ruling.
Nearly two years ago, the federal Departments of Health and Human Services, Labor, and the Treasury issued new guidance to clarify the coverage of PrEP as a preventive service under the Affordable Care Act.
The Centers for Disease Control and Prevention (CDC) noted that PrEP is a daily antiretroviral medication that “helps prevent high-risk individuals from acquiring HIV and is a powerful prevention tool to help end the HIV epidemic.”
“This clarification will reduce patient out-of-pocket costs and thus increase access to PrEP for high-risk individuals. While the war on HIV demands a multi-faceted approach, this is a significant step forward towards enabling better access to life-saving medication and eliminating a barrier to HIV prevention,” the CDC reported.
PrEP is a daily antiretroviral medication that helps prevent high-risk individuals from acquiring HIV. Daily PrEP use reduces the risk of getting HIV from sex (by 99 percent) and from injection drug use (by 74 percent), the CDC reported.
Despite its proven benefits, PrEP has been underutilized. Of the 1.1 million Americans who could benefit from PrEP, less than 10 percent of eligible users take the medication. The CDC reported there are also significant racial and ethnic disparities in PrEP use. Among those for whom PrEP is indicated, 44 percent are Black and 25 percent are Hispanic. Yet only 11 percent and 13 percent of those who began PrEP from 2014 to 2016 were Black or Hispanic, respectively. There are also gender gaps as women accounted for only 4.7 percent of those who filled PrEP prescriptions in 2016.
In June 2019, the USPSTF recommended that clinicians offer PrEP with effective antiretroviral therapy to those who face a higher risk of acquiring HIV. The USPSTF identifies persons at high risk of HIV as sexually active gay or bisexual men, heterosexual men or women, sex workers, and transgender people. The recommendation also applies to injection drug users with an additional risk factor such as shared use of drug injection equipment.
The federal mandate for coverage of screenings for unhealthy drug use in adults 18 and older also was recommended by the USPSTF. Unhealthy drug use includes using illegal drugs, such as heroin, or using a prescription drug in ways that are not recommended by a doctor.
The panel reported that an estimated 8 million people 12 or older met diagnostic criteria for drug dependence or abuse of drugs in the past year. The USPSTF concluded that screening by asking questions about unhealthy drug use in adults has moderate net benefit when services for unhealthy drug use or drug use, treatment, and care can be offered or referred.
Last year, for the first time, the USPSTF recommended screening for anxiety in children 8 and older. The CDC reported that between 2016 and 2019, about 5.8 million children were diagnosed with anxiety, and approximately 2.7 million were diagnosed with depression.
O’Connor’s ruling on preventive health care will likely add to a depressing reality that over the over the past four decades, life expectancy in America has been lagging behind other advanced nations. The N.Y. Times reported that mortality rates are hugely unequal across U.S. regions, with major coastal cities doing better “but the South and the eastern heartland doing far worse.”
A 2021 report in The Journal of Economic Perspectives looked into the cause of the regional differences and found part of the answer is the presence or absence of specific health policies.
“The most promising explanation for our findings involve efforts by high-income states to adopt specific health-improving policies and behaviors since at least the early 1990s. Over time, these efforts reduced mortality in high-income states more rapidly than in low-income states, leading to widening spatial disparities in health,” the report said.
Another factor in the lower life expectancy is that the poorest states still refuse to expand Medicaid, even though the federal government would cover the bulk of the cost.
The Times also reported that since the COVID-19 pandemic hit, people living in red counties have been far less likely to get vaccinated and far more likely to die of it than residents of Democratic-leaning counties, even though vaccines are free.
A Republican, Judge O’Connor, 57, was appointed to the federal bench in 2007 by President George W. Bush. He has long been active in the conservative, Federalist Society and many of his decisions reflect his conservative bent on issues like gun control, transgender rights,pandemic protections and his longstanding opposition to Obamacare.
Among his decisions, in 2015, O’Connor held that a portion of the federal Gun Control Act of 1968 was unconstitutional although the ruling was reversed on appeal. In 2016, O’Connor ruled against the Obama administration’s interpretation of Title IX rules that required that transgender students be allowed to use the bathroom that corresponds to their gender identity.
In 2016, O’Connor issued a preliminary injunction against enforcement of the Affordable Care Act as a likely violation of the Religious Freedom Restoration Act. In 2018, O’Connor ruled that the individual mandate under the Affordable Care Act was unconstitutional. The ruling was overturned by the Supreme Court.
In 2022, O’Connor issued a preliminary injunction blocking the Pentagon from enforcing a COVID-19 vaccine requirement for its Navy Seals. The preliminary injunction was partially stayed by the Supreme Court.