The Trump administration plans to defend the Affordable Care Act (ACA) mandate that requires insurers to fully cover certain preventive services, including HIV-prevention medication, regardless of religious affiliations. On February 18, the Justice Department filed a brief with the U.S. Supreme Court backing the Biden administration’s position in a case regarding whether employers can exclude such coverage on religious grounds.
The case originated in 2021 when Braidwood Management, a Texas company, sued the Department of Health and Human Services (HHS), claiming that the ACA’s requirement to cover HIV-prevention medication violated its religious beliefs. A district court ruling in March 2023 sided with Braidwood, blocking enforcement of preventive care recommendations by the U.S. Preventive Services Task Force (USPSTF) for private insurers. However, the 5th U.S. Circuit Court of Appeals issued a mixed ruling in June 2023, agreeing that Braidwood shouldn’t have to cover HIV-prevention medication but upholding most of the preventive care mandate.
The Justice Department’s brief argues that the USPSTF’s structure is constitutional and that its members are “inferior officers,” meaning they are legally appointed. It suggests that the HHS Secretary has the authority to supervise or override the task force’s recommendations before they are implemented by insurers.
The ACA’s preventive care mandate currently covers over 100 health services without copayments, benefiting more than 100 million people annually. The U.S. Supreme Court is expected to hear the case in the spring of 2025.
The Affordable Care Act’s requirement for insurers to fully cover expanded preventive services has undeniably enhanced access to healthcare for the American public. However, other aspects of the legislation, including the increase in average premium costs, have caused controversy since its enactment in 2010, indicating that further amendments are needed.
James Rodriguez, President and CEO of TexHealth, discusses the surprising impact of the Affordable Care Act on TexHealth’s mission to provide affordable health insurance for small businesses.
“Ever since 2010, and especially in 2013, I have not been a strong proponent of the Affordable Care Act (ACA)—not because of its merits, but because of its restrictions and requirements. In 2013, the ACA nearly put TexHealth out of business because it outlawed limited-benefit plans like ours.
The TexHealth health plan was an affordable and comprehensive option for small business employees who otherwise couldn’t afford coverage. It cost just $260 per month—yes, $260 total premium—and provided:
- 8 physician visits (primary care or specialist)
- $100,000 hospitalization benefits
- $4 copay for generic prescriptions
- Coverage for tests, imaging, rehabilitation, and childbirth
Our plan utilized UnitedHealthcare’s vast physician network and claims processing system, making it accessible and reliable. It was the kind of plan people would jump at today. However, due to the ACA’s regulations, we were forced to shut it down.
Rather than giving up, we regrouped and launched the TexHealth Premium Assistance Program. We’ve built our caseload back up to its previous level, but with the right financial resources, we could expand statewide and help many more Texans. That’s why we’re going to the Texas Legislature—to ask for more funding and the opportunity to scale statewide. Texas has the highest uninsured rate in the nation, and the need for affordable healthcare solutions has never been greater.
To be clear, I support the ACA’s preventive services—they save lives, just as
TexHealth did when it was a health plan. In fact, TexHealth was ahead of its time in promoting preventive care.
We offered a $40 discount on premiums for employees who:
- Saw their primary care provider within the first 60 days of enrollment
- Attended a health education seminar led by our TexHealth Nurse Manager
Back then, this was innovative and forward thinking—and I believe it still is today. With the right support, TexHealth can once again be a game-changer for Texans in need of affordable coverage.”