A Federal Judge’s Ruling to Block ACA Requirement for No-Cost Preventive Care Is Unpopular

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A decision from a federal judge in Texas last week to strike down an Affordable Care Act requirement for health plans to cover certain preventive services at no cost was met with immediate backlash from patient advocacy groups who said it would create uncertainty over the coverage of what can be life-saving care for hundreds of millions of people. 

The judgment is also unpopular with the general public: Half of U.S. adults said they disapprove of District Court Judge Reed O’Connor’s ruling, nearly double the share who said they approve of the decision, according to a new Morning Consult survey.

Democrats, Republicans and independents all more likely than not to disapprove of judge’s ACA ruling

• While half of U.S. adults said they either “strongly” or “somewhat” disapprove of O’Connor’s ruling, 28% said they approve of the decision and 22% said they do not know or have no opinion.
• A majority of Democrats (55%) and independents (51%) disapprove of the ruling, as do a plurality of Republicans (40%). Notably, an equal share of Democrats and Republicans (33%) said they approve of O’Connor’s decision. Among independents, 1 in 6 said they approve of the decision and nearly 1 in 3 said they do not have an opinion.
• Among all adults, 37% said they “definitely” or “probably” expect to delay or avoid health care due to potential costs following the ruling, while 41% said they do not expect to skip care and 22% said they do not know.
• Roughly 2 in 5 adults said O’Connor’s decision to block a piece of the ACA was outside of his jurisdiction, including 53% of Democrats and 31% of Republicans. Meanwhile, about 1 in 5  adults said O’Connor acted within his jurisdiction and nearly 2 in 5 said they do not know.
• Among all adults, 42% said federal judges in general have too much power, 27% said they have the right amount of power and just 4% said they don’t have enough power.

Insurers try to quell fears of loss of coverage after ACA ruling

O’Connor’s decision has led to questions about whether coverage will change going forward. The Biden administration appealed the ruling, sending the case to the U.S. Fifth Circuit Court of Appeals, which has a majority of Republican-appointed judges.

If upheld, the ruling could limit access to care like mental and behavioral health services, cancer and HIV screenings and health screenings for children.

Matt Eyles, chief executive of the insurer lobby group AHIP, said in a statement that “Americans should have peace of mind there will be no immediate disruption in care or coverage.” Some health insurers have also said that they will not make coverage changes yet.

Natalie Davis, CEO of the United States of Care and a former official for the Centers for Medicare and Medicaid Services, said the country “can’t go backwards” on preventive care such as cancer and mental health screenings. “When people are faced with the need to pay out of pocket for health care, they often don't use the health care that they need out of worry of cost,” Davis said. “So, this is a real concern.”

Davis added that it is a “really dangerous precedent that an appointed judge can impact the health care for over 150 million people and overrule doctors and nurses and experts who say these are necessary screenings.”

Despite the high-profile decision and news cycle that followed, few people have heard of the ruling. According to the survey, 65% of  adults said they have not seen, read or heard much or anything about the ruling, including 42% who said they have heard “nothing at all.”

The March 31-April 2, 2023, survey was conducted among a representative sample of 2,200 U.S. adults, with an unweighted margin of error of +/-2 percentage points.