Recent Court Rulings Endanger Public Health
Preventive care and reproductive health are bedrocks of public health—but in both areas, judges have recently intervened, undermining public health efforts and putting the nation's health at risk.
On March 30, a U.S. district court in Texas issued a ruling limiting the scope of the Affordable Care Act’s requirements for coverage of preventive services. If upheld, this decision would mean that insurers would no longer be required to cover certain vital preventive measures, including screenings for lung and skin cancer, statins that prevent cardiovascular disease, and pre-exposure prophylaxis (PrEP) medication, which provides effective prevention from contracting HIV. If insurers drop these protections, there will be profound consequences for our efforts to prevent disease, save lives, and extend the lifespans of Americans. You can learn more about the potential implications of this decision in a recent episode of our Public Health on Call Podcast.
Days after that decision, another district court judge in Texas invalidated the Food and Drug Administration's approval of mifepristone, which has been part of a two-drug regimen typically used for medication abortions and miscarriage management for more than 20 years. This decision aims to deny access to mifepristone nationwide, even in states like Maryland with protections for abortion rights.
This is the first time a court has invalidated the FDA’s approval of a medication over the objections of the FDA. This troubling decision sets a dangerous precedent for court interference in the FDA’s science-based decisions, and could lead to future challenges to the availability of other prescription drugs that have already gone through the rigorous FDA testing and approval process. Vice Dean Josh Sharfstein, a former principal deputy commissioner of the FDA, provides more perspective in his recent opinion piece for The New York Times. The issue was also covered in another recent episode of Public Health on Call. In addition, the School’s Bill & Melinda Gates Institute for Population and Reproductive Health has issued this statement.
The overall impact of these two rulings is uncertain, with both decisions under appeal. In the case of preventive care, while insurance providers may not be required to cover certain treatments, they can still choose to do so—and some have already indicated they will.
As for mifepristone, on Wednesday a federal appeals court blocked part of the trial judge’s ruling, allowing the drug to be procured in person, but no longer available by mail. Notably, the appeals court further restricted mifepristone by rejecting the carefully considered steps the FDA has taken over the last seven years to expand access—such as extending the window of time for the drug to be used, from 7 weeks of pregnancy to 10 weeks. This case is now likely headed for the U.S. Supreme Court.
While much remains in flux, what we do know for certain is that limits on preventive care and restrictions on reproductive care will harm Americans and deepen our already-significant health disparities. It is reckless for courts to disregard decades of clinical evidence on drug safety and effectiveness, and override the highly specialized expertise, methodologies, and mandate of public health agencies and expert groups to dismantle public health protections.
We cannot take our access to safe and effective health care for granted. We as a field must speak out about these judicial overreaches and continue to advocate for public health decisions informed by science, evidence, and proven benefits for health.
Ellen J. MacKenzie, PhD ’79, ScM ’75
Bloomberg Distinguished Professor