April 4, 2023

OLYMPIA, Wash. — Insurance Commissioner Mike Kreidler has sent a letter to Washington health insurers in response to last week’s U.S. District Court ruling on several of the Affordable Care Act’s preventive service benefits, requesting they continue the critical coverage of all recommended preventive services that individuals and families have relied upon since 2010.  

“I’ve urged the health plans doing business in Washington to continue covering all preventive services without cost-sharing for patients,” said Kreidler. “Millions of people rely on this benefit to get affordable coverage of early detection and prevention of serious medical conditions. After 13 years, this coverage has saved lives here in Washington and across the country.”

Kreidler’s office is also exploring all options including legislative solutions. 

Last Thursday, a U.S. District Court judge in the Northern District of Texas issued a ruling overturning some of the Affordable Care Act’s most popular preventive service benefits. The plaintiffs argued in Braidwood Management v. Becerra that some of the preventive services they were required to cover with no cost-sharing were unconstitutional and violated their religious rights under federal law. 

The ACA requires all health plans to cover preventive services recommended by three different organizations with no cost-sharing: 

• The U.S. Preventive Services Task Force
• The Advisory Committee on Immunization Practices
• The Health Resources and Services Administration, based on recommendations of the Women’s Preventive Services Initiative and the Bright Futures Program

This ruling applies to all preventive services recommended by the U.S. Preventive Services Task Force (USPSTF) since March 2010 when the ACA took effect. It also applies to any changes to previously recommended preventive services. It specifically calls out pre-exposure prophylaxis (PrEP), a medication taken to prevent HIV. 

In 2018, the Washington state Legislature put several key ACA benefits into state law. The law requires that beginning in 2018, state-regulated health plans must at least provide coverage for the same preventive services required by the ACA, as were in effect on December 31, 2016.  These services must be covered without cost-sharing.  

Recommendations that were made after 2016 could now be subject to cost-sharing, including anxiety screening for children and youth, depression screening for pregnant and postpartum women, and colorectal cancer screening in adults aged 45-49. 

The Biden Administration is expected to appeal the ruling.