Richard H. Hughes, IV, Member of the Firm in the Health Care & Life Sciences practice, in the firm’s Washington, DC, office, was quoted in Law360, in “ACA Ruling Could Mean Narrowed Benefits from Health Plans,” by Kellie Mejdrich. (Read the full version – subscription required.)

Following is an excerpt:

A Texas federal court's decision blocking the government from enforcing preventative services requirements under the Affordable Care Act could ultimately lead health plans to reduce coverage, attorneys and advocates say, underscoring how a suit driven by religious objections to policy could have broader implications for public health.

U.S. District Judge Reed O'Connor's March 30 order blocked the U.S. government from enforcing ACA provisions that require insurance coverage without cost-sharing for many preventative treatments, including HIV prevention drugs known as pre-exposure prophylaxis, or PrEP. …

Richard Hughes IV, an attorney and health policy adviser at Epstein Becker Green, said Judge O'Connor's March order and judgment outlines "a very universal remedy that is going to be very disruptive, because it really lifts two requirements off of payors, it lifts the requirement to cover, and it lifts the requirement to do it without cost-sharing."

"So to the extent that we continue to have coverage of any of these services, when new plans go into effect, they may still have some cost-sharing attached to them, and that discourages uptake," said Hughes, who is also representing the HIV+Hepatitis Policy Institute as an amicus in support of the federal government's appeal before the Fifth Circuit.

Cost pressures can push plans to reduce coverage when federal requirements go away. For example, attorneys noted earlier this year that plans are likely to drop coverage for out-of-network coronavirus testing when federal emergency designations end later this year and requirements lift for coverage without cost-sharing. …

Public health advocates are gearing up for a fight. But they also are still sorting through the decision to understand its impact. While Judge O'Connor's order blocks USPSTF recommendations that were made after the ACA was enacted, the task force was established under a 1984 law and was making recommendations long before the 2010 law was put into place, noted Hughes of Epstein Becker. …

Hughes, counsel for amicus on the appeal, said he's doubtful Congress will act given the political divisions. But he said he's planning to argue before the appellate court that "the administration can step in and institute processes and procedures to create appropriate accountability."

"This Congress is not going to pass legislation like that," Hughes said. "So I think the administration has to look at its options. I do think it has options."

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