Earlier this month, a three-judge panel of the New Orleans–based US Court of Appeals for the Fifth Circuit signaled it will affirm a lower-court ruling striking down the Affordable Care Act (ACA)’s requirement that private insurance plans cover preventive services at no cost to patients. Once the Fifth Circuit issues its expected ruling, the Supreme Court will get another chance to strike a grievous blow to the public’s health.

In September 2022, Judge Reed O’Connor of the US District Court in the Northern District of Texas (the court where many anti-ACA rulings originate) declared that the executive branch could not use the US Preventive Services Task Force to determine which services would be covered by the mandate. The 2010 ACA said all services given an “A” or “B” rating by the task force must be covered without co-pays or deductibles. After the ruling, the government appealed to the Fifth Circuit.

The Fifth Circuit (six of whose twenty-six judges were appointed by Donald Trump, and two of whom sat on the panel) is the same court that in 2022 ordered a lower court to review whether the United Airlines requirement that its employees be vaccinated against COVID-19 violated their religious rights. In areas outside health care, the Fifth Circuit, whose judges, like Supreme Court justices, are appointed for life, slapped limits on the authority of federal agencies as diverse as the Securities and Exchange Commission, the Environmental Protection Agency, and the Consumer Financial Protection Bureau.