Appeals Court decision protects access to no-cost preventive CRC screening

On June 7, the U.S. Court of Appeals for the Fifth Circuit reversed a district court decision that had ruled provisions in the Affordable Care Act (ACA), which provide for no-cost preventive screening for colorectal cancer and other conditions, unconstitutional. In the ACA, Congress sought to reduce barriers to colorectal cancer screening and other preventive services by requiring insurers to cover these without a co-pay. However, in September 2022, U.S. District Court Judge O’Connor in Texas ruled this unconstitutional because the U.S. Preventive Services Task Force (USPSTF), which develops preventive services recommendations, is a volunteer organization, and its recommendations are not reviewed by constitutionally appointed government officials.

The Colorectal Cancer Alliance and other patient advocacy groups urged the government to appeal the decision, and a stay was granted while the decision was reviewed by the Fifth Circuit. “The Colorectal Cancer Alliance is pleased with most of the Fifth Circuit’s decision as it protects no-cost access to potentially life-saving colorectal cancer screenings,” said Michael Sapienza, CEO. “Allowing insurers to charge for colorectal cancer screenings would have had an immediate negative and potentially devastating impact on colorectal cancer prevention.”

The original case was brought by two Christian companies that claimed requiring employer-sponsored health insurers to provide preventive HIV medicines was unconstitutional. The Fifth Circuit ruling exempts these two companies from that requirement and also indicates that members of the USPSTF should be approved by the Senate. The ruling also directs the lower court to review other preventive services, such as vaccines.

While the Fifth Circuit ruling is generally good news for colorectal cancer prevention, the Alliance and other patient groups will need to remain vigilant to protect these important aspects of the ACA. The Braidwood decision, which the Fifth Circuit largely overturned, is one in a long series of Texas rulings seeking to invalidate some or all of the ACA. Several of those decisions were made by Judge O’Connor, who ruled the law unconstitutional in 2018 and then overturned the law’s anti-discrimination requirement in 2019.