Threats to No-Cost Preventative Care Could Deepen Inequity and Drive More People into Medical Debt  

On March 4, the Fifth Circuit Court of Appeals will hear oral arguments in a case that could jeopardize access to no-cost preventive care for more than 150 million people. A ruling in Braidwood Management, Inc. v. Becerra, which was appealed by the Biden administration in April of 2023, could end up at the Supreme Court of the United States. 

This is a critical moment for advocates for health and economic justice to demonstrate the harm this ruling could have on people – especially those already struggling to afford the cost of health care.   

62% of the public thinks it is very important that no-cost preventive care stays in place

Source: KFF Health Tracking Poll – July 2019

Access to no-cost preventive care is one of the most popular components of the Affordable Care Act (ACA) and has helped millions of people get and stay healthy – covering things like cancer screenings, HIV/AIDS prevention drugs, and mental health services for new moms, and more without copays. The services covered, and now at risk, are based on sound research and medical expertise, and could worsen inequity in communities already struggling to make ends meet.  

That’s why Community Catalyst and a growing movement of local, state, and national partners are working together to share facts about the case and what is at stake.   

This case is the result of a concerning trend we are seeing in the courts of partisan/activist judges using their power to chip away at important protections within the ACA – and it could leave even more people with medical debt, delay important care, and more.  

What happened in Braidwood v. Becerra?

For thirteen years, the ACA has required most private health insurance plans to cover, without a co-pay or deductible, a range of preventive health care services recommended by the United States Preventive Services Task Force.  

However, Braidwood v. Becerra threatens to eliminate that protection by allowing insurers to charge co-pays and deductibles for several types of preventive care – including vaccines. This jeopardizes access to preventive care for over 150 million people across the country.  

The case centers around pre-exposure prophylaxis (PrEP), a medication proven to reduce the risk of HIV transmission. Plaintiffs have made the discriminatory claim that covering PrEP and its related medical services, at no-cost, violated “their religious beliefs by making them complicit in facilitating homosexual behavior, drug use, and sexual activity outside of marriage between one man and one woman.” A federal judge in Texas ruled in favor of these plaintiffs, meaning health insurance plans now have the option to drop coverage for PrEP entirely or impose cost sharing if they claim a religious objection.  


  • On September 7, 2022, Judge Reed O’Connor issued a ruling in the case Braidwood Management v. Becerra, a lawsuit that challenges the requirement that most health plans cover preventive services at no cost under the Affordable Care Act. 
  • On March 30, 2023, this same federal judge issued another ruling, clarifying his decision applies nationwide and not just to the parties involved in this case. With this additional ruling, access to a range of critical preventative care for more than 150 million people is now at risk – including approximately 37 million children. 
  • On April 13, 2023, the Biden administration received a stay in the case, successfully arguing that “[e]fforts to strip away access to preventive health care are harmful and unacceptable.” This helped ensure that coverage for no-cost care would still be made available while the case made its way through the appeals process. 
  • On August 7, 2023, a cross-appeal was filed with the Fifth Circuit Court of Appeals to expand the scope of the challenge, further threatening no-cost access to the full range of ACA preventive services
  • On March 4, 2024, the Fifth Circuit Court of Appeals will hear oral arguments. The future of free preventive care will likely be decided by the Supreme Court. 
“We will not stop fighting until everyone has equitable access to the care they want and need to be healthy.”
Emily Stewart, Executive Director, Community Catalyst

What People are Saying 

According to The New York Times, some insurers have said they plan to continue offering the services at no cost, “regardless of the final outcome of this court case.” But the lack of a mandate could eventually cause some employers or insurers to cut back on such coverage, particularly for more costly services. 

Take Action

On June 6, 2023, United States of Care and Community Catalyst hosted a webinar to update state partners on Braidwood v. Becerra, providing insights regarding the legal, clinical, equity, legislative, and community implications of the ruling and offering resources and actions for states to protect preventive services. You can watch a replay of the webinar here, access the English-language transcript here, and view the slides here

Learn more

To learn how advocates can respond to this decision, download our pdf below. 

Add your name to tell insurance companies to keep preventative care free.

If you want to join the conversation, please visit our Soapboxx page and record your story!