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A pharmacist writes a prescription in New York City.

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A federal judge on Thursday struck down an Obamacare mandate that requires most private health insurance plans to offer free screening services, which include everything from screening for certain types of cancer and diabetes to drugs used to prevent HIV.

The ruling by Judge Reed O’Connor of the US Northern District Court of Texas applies to medications, screenings and other forms of health care recommended by an independent panel of experts called the Preventive Services Task Force.

Under the Affordable Care Act, private health plans were required to cover mammograms for breast cancer in women ages 50 to 74, as well as screening for colon, cervical, and lung cancer.

The mandate also included drugs that prevent HIV infection in high-risk groups, called pre-exposure prophylaxis, or PrEP. Most private plans also had to cover screening for certain sexually transmitted infections, such as chlamydia and gonorrhea.

Obamacare requirements included screening for type 2 diabetes, among many other forms of health care.

Lawrence Gostin, a leading health law expert, said full coverage of these essential services with no out-of-pocket expenses is now in jeopardy.

“The overall picture is crystal clear. Virtually everything Americans rely on to keep themselves and their families healthy and prevent disease will no longer be required under the Affordable Care Act,” said Gostin, a professor at the Georgetown University Law Center.

Here’s a full list of precautionary measures that the judge’s ruling is likely to apply to

The Biden administration is likely to appeal the verdict. The US Department of Health and Human Services, which oversees Obamacare regulations, did not immediately respond to a request for comment.

Senate Majority Leader Chuck Schumer, DN.Y., called on the Biden administration to immediately appeal the verdict. He also called on insurers to publicly commit to free preventive care.

“Not only is this judgment misguided, it is downright dangerous and could cost lives,” Schumer said.

Gostin said most private insurance plans will likely continue to cover these preventative health services, but will charge deductibles and co-payments.

“It will primarily affect working-class Americans,” he said, noting that many people will forgo basic health care because they cannot afford the out-of-pocket costs.

O’Connor’s ruling said that coverage requests based on recommendations from the Preventive Services Task Force were unlawful because the panel’s members were not nominated by the President and confirmed by the Senate. Therefore, the federal government cannot enforce a supply mandate on the basis of these recommendations, he said.

The Prevention Services Task Force is made up of 16 volunteers who are doctors, nurses, public health experts, and other medical professionals. They are appointed by the director of a federal organization called the Agency for Healthcare Research and Quality.

The judge’s ruling came after two Christian companies and several individuals sued the federal government in 2020. The lawsuit argues that the precautionary mandate violates their freedom of religion because it includes coverage for drugs to prevent HIV infection.

Plaintiffs allege in their lawsuit that the PrEP mandate “compels religious employers to insure drugs that facilitate and encourage homosexual behavior, prostitution, sexual promiscuity and injecting drug use.”

They also alleged that the Preventive Services Task Force’s recommendations were invalid because the process used to select the panel’s members violated the U.S. Constitution’s nomination clause.

O’Connor, in the same decision Thursday, dismissed an argument by plaintiffs to also overturn the mandate requiring Obamacare-compliant birth control coverage plans without out-of-pocket expenses.

Two federal judges are poised to soon issue rulings in dueling cases that could dramatically affect access to the abortion pill mifepristone.

In Washington state, US District Judge Thomas Rice is considering whether to scrap federal regulations on mifepristone that make access difficult even when abortion is legal. He’s also considering issuing an injunction that would prevent the Food and Drug Administration from taking action to take the pill off the market or reduce its availability.

In Texas, US District Judge Matthew Kacsmaryk is considering ordering the FDA to withdraw mifepristone from the US market. Medical groups, which oppose abortion, sued the FDA in November to overturn the drug’s more than 20-year-old approval.

Rice heard arguments Tuesday in Spokane from the FDA and the legal team representing a coalition of Democratic attorneys general who filed the lawsuit against the agency. The entire hearing lasted less than an hour.

Kacsmaryk heard arguments in the Texas case earlier this month and said he would issue an order as soon as possible. Kacsmaryk was appointed by former President Donald Trump, and Rice was appointed by former President Barack Obama.

“When we made our complaint, we were obviously well aware of what was going on in Texas. That’s just the legal world we live in,” said Washington State Attorney General Bob Ferguson, who is leading the lawsuit to keep mifepristone on the market and expand access to the drug.

The US is now braced for the possibility that two federal district courts could issue conflicting rulings on the abortion pill, potentially adding further confusion to an already complex web of state regulations on mifepristone.

The cases also suggest that the Supreme Court could eventually become embroiled in the escalating legal battle over the most commonly used method of abortion in the United States

“If we get two diametrically opposed rulings on what the FDA should do, it will almost certainly go to the US Supreme Court,” wrote Glenn Cohen, a former attorney with the Civil Division of the Justice Department and a Harvard Law School professor, in an email. Cohen signed a brief in the Texas case supporting FDA approval of mifepristone.

Ferguson said the Washington case urges the judge to expand and protect access to mifepristone, particularly in the 17 states plus the District of Columbia that are parties to the lawsuit. In the Texas case, anti-abortion medical associations are asking the judge to remove the abortion pill from the US market statewide.

If the Texas judge rules first and orders the FDA to take mifepristone off the market, the Washington judge could still issue an order that at least preserves access in the 17 states and DC, Ferguson said.

“The federal judge in Washington will rule on Washington, and that would preserve it in Washington State and the plaintiff states,” Ferguson said. “But you would have competing court orders, and sometimes that’s resolved on appeal.”

“You could have a situation where it’s not available in some states and it’s available in some states. All of these things are possible. But a lot depends on how those judges write those decisions,” Ferguson said.

The FDA has placed restrictions on mifepristone under a government surveillance program since it approved the pill in 2000, but the agency has gradually eased those restrictions over the years. In January, the requirement for patients to receive the pill in person was finally ended, allowing mifepristone to be mailed. The FDA also allowed retail pharmacies to begin dispensing the pill for the first time.

But the agency has retained some caveats. Patients must sign a form outlining the risks of mifepristone, and they must obtain a prescription from a health care provider certified under the federal surveillance program. Pharmacies must also be certified under this program in order to dispense the drug to the patient.

Ferguson and the other attorneys general are asking the Washington state judge to lift those restrictions. The 17 states include Arizona, Colorado, Connecticut, Delaware, Illinois, Michigan, Nevada, New Mexico, Oregon, Rhode Island, Vermont, Hawaii, Maine, Maryland, Minnesota, Pennsylvania and Washington.

“It only serves to make mifepristone harder for physicians to prescribe, harder for pharmacies to fill, harder for patients to access, and harder for plaintiff states and their healthcare providers to distribute,” the attorney general told the judge in their complaint.

Cohen said the lawsuit in Washington raises questions about whether the Biden administration would appeal a decision ordering the FDA to drop mifepristone restrictions.

The White House may not want to explain why it defends barriers to medical abortion, even though the FDA likely wants to protect its regulator, Cohen said. It’s possible that the Biden administration would not appeal if they lost in Washington state and simply dropped remaining restrictions on the abortion pill, he added.

However, Ferguson noted that on Tuesday the government decided to defend the restrictions in court: “It was not like they said, ‘Ferguson is right, we shouldn’t have these restrictions.’ They fight it, they defend it. So what they would do if we prevailed, I don’t know.”

Rachel Rebouche, a reproductive health law expert at Temple University, said the Washington and Texas cases raise the prospect of Supreme Court involvement. Rebouche signed a brief in the Texas case defending the FDA’s approval of mifepristone.

When district court cases in Washington and Texas are challenged in the 9th Circuit and 5th Circuit Courts of Appeals, respectively, and those circuit courts return conflicting judgments, “then those are issues that take precedence for the Supreme Court,” Rebouche said.

A narrow majority of the 9th Circuit Court justices were nominated by Democratic presidents, while an overwhelming majority of the 5th Circuit Court justices were nominated by Republican presidents.

Oregon Attorney General Ellen Rosenblum, who co-chaired the lawsuit in Washington with Ferguson, said she was concerned that the case would fall after the court’s decision last year to uphold abortion rights under Roe v. Wade would end up in the Supreme Court.

“We don’t necessarily want to make this a US Supreme Court case,” Rosenblum said.

The Laboratory Corporation of America will pay $2.1 million to settle allegations that it overcharged the Defense Department for genetic testing involving children and fetuses, the Justice Department announced Monday.

A former Lab Corp Whistleblower-turned employee Donna Hecker-Gross sued the diagnostic testing company under the False Claims Act on behalf of the federal government in 2018. The civil complaint was filed in the US District Court for the District of Maryland.

Hecker-Gross will receive $357,000 as part of the settlement, according to the DOJ.

Hecker-Gross’ allegations involved genetic testing performed under a contract LabCorp struck with the Department of Defense in 2012. Under the terms of the contract, the company provided laboratory testing for Department of Defense military treatment facilities around the world, including testing it paid genetic testing company GeneDx to perform.

Hecker-Gross alleged that LabCorp overcharged and double- or triple-billed DOD for genetic testing performed by GeneDx. Thirty-eight tests were overcharged by $210,959, including $113,525.50 for 21 tests billed between March 2016 and January 2017 alone, according to the lawsuit.

The lawsuit alleges that in 2017, employees at Walter Reed National Military Medical Center first questioned LabCorp about charges for a particular test that screens for genetic abnormalities in children and fetuses. The test costs between $5,000 and $10,000, the lawsuit says.

The test typically performs two or three analyzes on DNA samples from a child or fetus and one or both biological parents. Under the contract, LabCorp pays GeneDx for only one test and should only charge the DOD for a single test and a small fixed fee.

But Walter Reed’s staff noted that LabCorp billed the military facility for analysis of DNA samples from parents in addition to analysis of samples from children or fetuses, according to the lawsuit. LabCorp insisted the company had appropriately billed for the tests until Hecker-Gross sought confirmation of GeneDx’s billing practices, according to the lawsuit.

LabCorp then found that it had billed the DOD “two or three times what it paid for the test and breached the contract with the difference,” according to the lawsuit.

Even after that discovery, LabCorp conducted only a limited investigation that “did not reveal the magnitude and scope of the problem,” according to the lawsuit. The company only reviewed billing records for tests performed at Walter Reed between March 2016 and July 2017, according to the lawsuit, despite years of testing at military treatment facilities worldwide, according to the lawsuit.

LabCorp also did not fail to pay the department back for overbilling it uncovered, the lawsuit says. It only offered Walter Reed a credit for double- or triple-billed tests from January 2017, with a promise to fix the problem in the future.

Hecker-Gross repeatedly complained about LabCorp’s improper billing to her line managers until the company fired her on Aug. 8, 2017, the lawsuit states.

“She believed that LabCorp was responsible for repaying all the overcharges, not just for the short period of time they offered,” Peter Chatfield, the attorney representing Hecker-Gross, told CNBC. “She pressured her to pay for everything and she got fired for that. That made her come forward as a whistleblower.”

Chatfield noted that Hecker-Gross was “pleased” with the settlement.

Scott Moreland, special agent in charge of the Army Criminal Investigation Division’s Major Procurement Fraud Field Office, said in the Justice Department’s press release that he was “very pleased” with the announcement of the settlement.

“This is a true testament to our continued commitment to working closely and seamlessly with our world-class law enforcement community to protect the financial interests of the U.S. Army and the overall United States government,” he said.

LabCorp said in a statement to CNBC that the company does not comment on litigation.

“It is important to note that this settlement is not an admission of wrongdoing, and Labcorp has vigorously denied the allegations in this case,” the company said. “Labcorp entered into the settlement to avoid the costs and burden of litigation.”

Shares of the Burlington, North Carolina-based company were relatively flat following the Justice Department’s announcement.

LabCorp is one of the nation’s largest providers of clinical laboratory services and has become best known for manufacturing and distributing Covid test kits during the pandemic.

For more than two decades, the company has faced a number of lawsuits related to its billing practices. Just last month, the company agreed to pay $19 million to resolve allegations that it violated the False Claims Act by making false claims on Medicare. In 1996, LabCorp agreed to pay $187 million for fraudulently charging the government for unnecessary testing of elderly patients.