Preventive Care Coverage at Risk: Texas Lawsuit Targets Affordable Care Act Mandates

Preventive care is the backbone of modern healthcare. From cancer screenings and cholesterol tests to vaccines and reproductive health services, these essential services allow doctors to detect illnesses early and reduce long-term costs for patients and the healthcare system. Under the Affordable Care Act (ACA), preventive services recommended by medical experts are covered by most insurance plans at no cost—meaning no copays, deductibles, or out-of-pocket expenses.

But in recent years, this cornerstone of the ACA has come under fire in court. A Texas lawsuit has challenged the constitutionality of how preventive care coverage is mandated, raising serious concerns about the future of free access to cancer screenings, HIV prevention, and other lifesaving services. While the U.S. Supreme Court ultimately upheld these protections in 2025, the case highlights the fragility of preventive care coverage and the ongoing political battles surrounding healthcare in America.

What’s at Stake

The ACA requires insurance companies to cover preventive services based on recommendations from three expert groups:

·         U.S. Preventive Services Task Force (USPSTF) – Screens and tests (e.g., mammograms, colonoscopies, HIV testing).

·         Advisory Committee on Immunization Practices (ACIP) – Vaccines.

·         Health Resources and Services Administration (HRSA) – Women’s and children’s health services, including contraception.

This means that approximately 150 million Americans currently access screenings, medications, and vaccines without paying out-of-pocket. If overturned, insurers could reintroduce copays or deny coverage altogether, making preventive care unaffordable for many.

The Texas Lawsuit: Braidwood Management v. Becerra

The lawsuit, originally filed by Christian-owned businesses and individuals in Texas, argued two main points:

1.      Constitutional Challenge – The plaintiffs claimed that the USPSTF was improperly structured. Since its members are not appointed by the President or confirmed by the Senate, they argued that mandating coverage based on its recommendations violated the Constitution’s Appointments Clause.

2.      Religious Freedom Challenge – The plaintiffs also objected to being required to cover PrEP, a medication that prevents HIV transmission. They claimed it conflicted with their religious beliefs, framing the requirement as a violation of their rights under the Religious Freedom Restoration Act (RFRA).

In 2023, Judge Reed O’Connor of Texas sided with the plaintiffs, ruling that coverage mandates based on USPSTF recommendations made after 2010 were unconstitutional and that the PrEP requirement violated religious rights. This threatened to roll back free coverage for a wide range of services, from new cancer screenings to statin medications for heart disease prevention.

The Appeals and Supreme Court Ruling

The case moved through the appeals process, and in June 2025, the U.S. Supreme Court issued its ruling. In a major decision, the Court determined that the USPSTF’s structure does not violate the Constitution. The justices reasoned that USPSTF members are considered “inferior officers” since the Health and Human Services (HHS) Secretary has the authority to oversee and replace them, and coverage decisions ultimately require HHS approval.

This ruling preserved the ACA’s preventive care mandates, ensuring that Americans would continue to receive no-cost coverage for:

·         Mammograms

·         Colon cancer screenings

·         Statin medications

·         HIV prevention (PrEP)

·         Vaccinations

·         Blood pressure, cholesterol, and diabetes screenings

Had the Court ruled otherwise, insurers could have started charging for these services or dropped coverage entirely—making preventive care less accessible and potentially widening health disparities.

Why Preventive Care Matters

Preventive care is not just a health issue—it’s also an economic one. According to public health experts, the ACA’s no-cost preventive care provision has led to increased screening rates, earlier detection of disease, and improved health outcomes. Examples include:

·         Cancer – Free mammograms and colonoscopies have helped detect breast and colorectal cancers earlier, when treatment is more effective.

·         Heart Disease – Cholesterol and blood pressure screenings have reduced risks of heart attack and stroke.

·         HIV Prevention – Access to PrEP has dramatically lowered HIV transmission rates in high-risk populations.

·         Vaccinations – Flu shots, HPV vaccines, and COVID-19 vaccines help prevent widespread illness and reduce healthcare costs.

Without guaranteed coverage, many patients would delay or skip these services due to cost, leading to higher rates of advanced disease, more expensive treatments, and preventable deaths.

The Broader Debate

Although the Supreme Court upheld the preventive services mandate, the case highlights a larger debate: Should evidence-based healthcare decisions be insulated from politics, or should elected officials have more oversight?

Critics of the ACA argue that expert panels like the USPSTF have too much power without direct accountability. Supporters counter that allowing political interference in medical recommendations could undermine scientific integrity and jeopardize public health.

There are also concerns about religious exemptions. While the Court did not overturn PrEP coverage nationwide, ongoing legal challenges could expand the ability of employers to deny preventive services based on religious or moral objections.

What This Means for Patients

For now, patients can breathe a sigh of relief: preventive services remain covered at no cost under the ACA. That means:

·         Your annual wellness visits are still free.

·         You won’t face copays for mammograms, Pap smears, or cholesterol screenings.

·         Preventive medications like PrEP and statins are still covered.

·         Vaccinations remain available without cost-sharing.

But the case also serves as a reminder that these protections are not guaranteed forever. Healthcare policy remains a hot-button issue, and preventive care coverage could face renewed challenges in the future.

Final Thoughts

The Texas lawsuit against the ACA’s preventive care mandate raised alarm bells for millions of Americans who rely on free access to screenings, medications, and vaccines. While the Supreme Court ultimately upheld the law in 2025, the case underscores how fragile healthcare protections can be—and how quickly they can come under threat.

Preventive care saves lives and saves money. Rolling back these protections would have disproportionately harmed women, low-income families, and communities already facing health disparities. For now, the system remains intact, but continued vigilance is needed to protect these critical healthcare benefits