(The Hill) — A federal judge in Texas struck down a key provision of the Affordable Care Act (ACA) that requires insurers and employers to cover preventive services for free, including cancer screenings and HIV drugs.

The ruling by Judge Reed O’Connor of U.S. District Court for the Northern District of Texas — who previously struck down the entire ObamaCare law before it was upheld by the Supreme Court — applies nationwide.

It immediately jeopardizes access to treatment for the approximately 100 million Americans who use free preventive services annually, and it leaves the door open for insurers to impose deductibles and copays for potentially life-saving screening tests.

The ACA requires insurers to cover, without cost-sharing, more than 100 preventive health services recommended by the U.S Preventive Services Task Force. Cost sharing will likely deter patients — particularly those of limited means — from scheduling mammograms, colonoscopies and other procedures.

O’Connor ruled that the panel itself is unconstitutional because its members, which include 16 volunteer scientists and medical professionals, are not appointed by the president or confirmed by the Senate, yet its recommendations are binding.

O’Connor’s decision was not unexpected. He ruled last year the preventive services mandate was unconstitutional, but at the time waited to decide on the scope of remedy. 

O’Connor also invalidated ObamaCare’s HIV treatment mandate, saying it violated the Religious Freedom Restoration Act by forcing the plaintiff, a Christian employer and well-known GOP donor, to pay for insurance that covers HIV prevention drugs.

The company’s owner argued HIV drugs, known as PrEP, promote homosexual behavior that conflicts with their faith and personal values. 

PrEP reduces the risk of getting HIV by 99% when taken as recommended, according to the Centers for Disease Control and Prevention. There are two pills approved for use as PrEP: Truvada and Descovy. The drugs are also recommended for monogamous partners of people with HIV and people who share needles and other drug paraphernalia.

The lawsuit was led by Jonathan Mitchell, the architect of Texas’s six-week abortion law that offers a $10,000 bounty to private citizens who successfully sue abortion providers.

It is likely that the Biden administration will appeal, but if the conservative judges on the Fifth Circuit Court of Appeals uphold the order, ObamaCare could once again go to the Supreme Court.