A federal judge in Texas on Thursday struck down a key provision of the Affordable Care Act, known as obamacareand put like this at risk a range of preventive services, including cancer and mental health screenings. Judge Reed O’Connor, who has already issued several rulings against Barack Obama’s 2010 healthcare law, has upheld the claim of a group of conservative businessmen in Texas who argue that those provisions are unconstitutional.

The ruling annuls the recommendations of the Preventive Services Task Force, whose task is to determine which preventive treatments required by law are covered under insurance at no cost to the patient. O’Connor has ruled that such a team is unconstitutional because its members, which are 16 volunteer scientists and medical professionals, are not appointed by the president or confirmed by the Senate, yet their recommendations are binding.

It also finds it illegal to require insurance companies and employers to offer health care plans that cover measures for HIV prevention at no cost to the user. In the opinion of the judge, the obligation to cover the prophylactic drug PrEP violates the religious rights of employers and therefore should not apply to them.

The decision can be appealed and the US Department of Justice has the option to request that O’Connor’s ruling be suspended while the appeal is processed. The White House spokeswoman, Karine Jean-Pierre, has indicated that the Justice and Health Departments are already reviewing the court ruling to decide what the next steps are and has lashed out at it, asserting that “attacks” the right of Americans to decide about their health.

O’Connor’s ruling immediately jeopardizes the access to treatment for some 100 million people who in the United States use preventive services each year. In addition, the decision leaves the door open for insurers to impose deductible fees and additional payments for obtaining tests and tests that can save lives.

In January, the Joe Biden government announced that approximately 15.9 million people had signed up the previous year for the various plans covered by the law. Republicans in Congress, who opposed passage of the rule, have repeatedly moved to strike it down and have failed. Already during his 2016 campaign, Donald Trump promised that he would nullify it and would replace it with something better, but it didn’t get enough support either, and the law still stands.