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Image: Pedro Rojas holds a sign directing people to an insurance company where they can sign up for the Affordable Care Act, also known as Obamacare
A sign directs people to an insurance company where they can sign up for the Affordable Care Act, also known as Obamacare, in Miami in 2015.Joe Raedle / Getty Images file

Notorious judge strikes down ACA’s preventive coverage benefits

The ACA requires health insurers to provide a series of free preventive care services. A notorious Texas judge just put those benefits in severe jeopardy.


For the Affordable Care Act, everything’s coming up roses. As regular readers know, not only have all of the Republican predictions about the failure of “Obamacare” been discredited, but the ACA is clearly effective, popular, affordable, and expanding. What’s more, it’s withstood three U.S. Supreme Court rights, and Republican politicians have generally waved the white flag and abandoned their “repeal and replace” nonsense.

As a New York Times headline summarized yesterday, “Obamacare Keeps Winning.”

At least, the landmark reform law keeps winning everywhere except U.S. District Judge Reed O’Connor’s courtroom. USA Today reported this afternoon:

A federal judge in Texas blocked enforcement Thursday of preventative health care mandates included in the Affordable Care Act, setting up the latest legal brawl over Obamacare and threatening to reduce free access to HIV-prevention pills, screenings for cancer and other services.

A Politico report added that O’Connor already sided with the plaintiffs, but he hadn’t said whether his ruling would apply only to the people suing, to everyone in Texas, or nationwide. This morning, in Braidwood Management v. Becerra, the judge issued a “universal” ruling, applying his decision to the entire national marketplace.

Or put another way, the Affordable Care Act requires health insurers to provide a series of free preventive care services — from cancer screenings vaccinations, prenatal services to HIV prevention, pap smears to heart disease screenings — to the benefit of tens of millions of Americans. One notorious jurist has decided to put those benefits in jeopardy.

Naturally, the anti-health care ruling will be appealed, and there’s no reason to automatically assume that this district court ruling will be upheld.

But in the meantime, it’s worth pausing to appreciate just how indefensible O’Connor’s judicial activism has become.

On the surface, the judge struck down the ACA’s preventive coverage benefits because they were recommended by the U.S. Preventive Services Task Force, and O’Connor said its members hadn’t been subject to the Senate confirmation process. He was also apparently persuaded by the Texans who brought the case, who — I’m not kidding — argued that requiring people to pay for insurance plans that cover STD screenings and HIV prevention drugs would “facilitate and encourage homosexual behavior, prostitution, sexual promiscuity, and intravenous drug use.”

But let’s not kid ourselves: O’Connor started with the conclusion and worked backwards to arrive at his preferred outcome. I can say that with some confidence because this guy has a well-earned reputation.

Revisiting our coverage from September, it’s probably safe to assume most Americans have never heard of Judge Reed O’Connor of the Northern District of Texas, but he’s infamous for a reason.

The week before Christmas in 2018, for example, a judge agreed to strike down the entirety of the Affordable Care Act, root and branch. Even many conservatives and ACA critics agreed that the ruling was indefensible, and reactions tended to include words and phrases such as “pretty bananas,” “embarrassingly bad,” and “absurd.”

It was O’Connor, of course, who issued the ruling. The New York Times noted soon after that Republicans had a habit of bringing their cases to this specific district court because of their confidence that O’Connor would give them everything they wanted.

He ruled for Texas in 2015 when it challenged an Obama administration measure extending family leave benefits to married same-sex couples. ... He also ruled for Texas in 2016, blocking the Obama administration from enforcing guidelines expanding restroom access for transgender students.

Last year, the same judge, nominated by George W. Bush, also undermined the Navy’s vaccine requirements, ignoring generations’ worth of precedent.

If you’re thinking that the plaintiffs in this case filed in the Northern District of Texas, specifically in the hopes that their lawsuit would reach O’Connor, who in turn would deliver a predictable ruling, you’re not alone.

This post revises our related earlier coverage.