Dear YSPH Community Members,
On Thursday, March 30, a federal judge in Texas issued a nationwide injunction on provisions of the Affordable Care Act requiring employers and insurers to cover a broad range of preventive services. This deeply disappointing ruling could impact more than 150 million people who rely on employer health insurance and Obamacare for effective, science-based preventive health care, including mammograms, colonoscopies, pregnancy-related monitoring, mental health and diabetes screening, and HIV prophylaxis.
The judge in the case ruled in favor of plaintiffs who argued that it was unconstitutional to link insurance coverage mandates to the recommendations of a volunteer panel (the U.S. Preventive Services Task Force) because its members are private medical experts who advise the government but are neither government employees nor appointed by the President or confirmed by the Senate. The plaintiffs also singled out pre-exposure prophylaxis (PrEP) for HIV, arguing that mandated coverage of this proven harm-reduction strategy infringed on their religious freedoms.
As of today, the full impact of the ruling remains unclear. While the injunction order takes effect immediately, many health insurers and employers have said their existing contracts are in place for a year and any major changes in coverage will most likely happen next year. It is expected that the Biden administration will appeal the decision and ask for a stay of the injunction, but no decision has been made as yet.
The court’s ruling, if upheld, will undermine years of effort and investment to contain and prevent a host of health risks and to end the HIV epidemic in the United States. Research led by faculty at the Yale School of Public Health suggests that the Texas court’s ruling will result in more than 2,000 entirely preventable HIV infections among men who have sex with men – and many more infections in other populations at high risk of HIV transmission – in one year alone. This burden will be imposed disproportionately on Black and Latino gay and bisexual men, as well as transgender women, who already face significant barriers to prevention and care. You can learn more about the potential impact of the federal decision here.
Expanding access to preventive services is a cornerstone of public health. The Yale School of Public Health remains committed to the human right to health for all and to our evidence-based contributions to public policy and information.
Melinda Pettigrew, PhD
Anna M. R. Lauder Professor of Epidemiology
Yale School of Public Health
A. David Paltiel, PhD
Professor of Public Health (Health Policy)
Public Health Modeling Unit
Yale School of Public Health & Yale School of Management