The U.S. Court of Appeals for the Fifth Circuit on Friday sided with Christian-owned businesses and individuals who challenged an Affordable Care Act mandate that private insurers cover certain preventive care services, finding a task force that recommends the services to be covered is unconstitutional.
But calling its opinion “a mixed bag,” the Fifth Circuit also lifted an injunction that would have blocked the government from enforcing the mandate nationwide. Judges Irma Ramirez, Don R. Willett and Cory T. Wilson called the nationwide injunction unnecessary and said U.S. District Judge Reed O’Connor of the Northern District of Texas abused his discretion in issuing relief beyond the plaintiffs.
“Though this case concerns federal law and necessarily implicates concerns of nationwide uniformity, it does not fall into one of the narrow categories that we have previously identified as particularly appropriate for universal injunctive relief,” Willett wrote for the Fifth Circuit.
“The district court likewise did not explain why, apart from vacatur under the APA, the universal injunction was necessary,” Willett added, referring to the Administrative Procedure Act. “We must therefore conclude that it was an abuse of discretion to enter universal injunctive relief after already providing complete relief to the plaintiffs.”
In the underlying suit, the plaintiffs raised religious objections to a 2019 recommendation from the U.S. Preventive Services Task Force that drugs that prevent HIV transmission be fully covered, along with other preventive care coverage requirements under the health care law.
The Fifth Circuit said the task force’s members were not properly appointed under the Constitution’s appointments clause, so the secretary of the Department of Health and Human Services cannot require that certain preventive services be covered. The task force is a 16-member administrative body of expert members created under the 2010 statute.
“We hold that members of the Task Force are principal officers under Article II of the Constitution who must be—yet have not been—nominated by the president and confirmed by the Senate,” Willett wrote.
The plaintiffs also argued that two other administrative bodies that issue guidelines for mandatory preventive-care coverage also violate the Constitution: the Advisory Committee on Immunization Practices and the Health Resources and Services Administration. The three administrative bodies make coverage recommendations ranging from cancer-detection procedures to physical therapy for older adults, the Fifth Circuit said.
“We are disinclined to decide questions without sufficient briefing, particularly ones of high stakes and of constitutional import,” Willett wrote. “We think it prudent for the district court to consider these arguments in the first instance. Once it does, we will be better positioned to weigh in on issues that affect not only the parties to this case, but evidently so many of the interested stakeholders in this circuit that the many amici represent.”
The U.S. Department of Justice declined to comment on the decision.
The plaintiffs were represented at oral argument by Jonathan F. Mitchell. Mitchell previously served as the solicitor general of Texas and recently notched a win for former President Donald Trump at the U.S. Supreme Court when the justices said states can’t remove presidential candidates from their ballots under the 14th Amendment.
“We are pleased that the Fifth Circuit agreed with our arguments and held that the Affordable Care Act violates Article II’s Appointments Clause by empowering the U.S. Preventive Services Task Force to dictate the preventive care that private insurers must cover,” said Gene Hamilton, director of America First Legal, which also represented the plaintiffs. “Today’s decision is a victory for the Constitution, the rule of law, and every American who does not want unelected bureaucrats making decisions about their healthcare coverage.”