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A federal judge in Texas has invalidated a key provision of the Affordable Care Act (ACA), which required that preventive care services, including mental health screenings, mammograms, and colonoscopies, be covered without cost-sharing for approximately 168 million people with employer-based health insurance or coverage on the individual market.

The ruling also struck down the ACA’s requirement that health plans cover pre-exposure prophylaxis (PrEP), which prevents the transmission of HIV, arguing that the requirement violated the religious rights of employers. The judge found that the U.S. Preventive Services Task Force, which recommended the services to be covered, acted unconstitutionally because its members are not government employees. The decision does not affect coverage for free vaccines, which are covered under a different section of the law.

The ruling is expected to be appealed by the Biden administration and could potentially be heard by the conservative-leaning Fifth Circuit Court of Appeals. The decision comes as part of a years-long fight by conservatives to undo the ACA.

While the ruling is unlikely to have an immediate effect, health insurance experts warn that patients could be deterred from seeking out services for fear of being hit with a medical bill. Congress could rectify the situation by passing a bill that requires coverage of services recommended by the U.S. Preventive Services Task Force.

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