Supreme Court to Decide on ACA Preventive Care Coverage Mandate

The U.S. Supreme Court is set to hear Kennedy v. Braidwood Management, a case challenging a key Affordable Care Act (ACA) provision requiring private insurers to cover preventive health services at no cost. Since 2010, this ACA mandate has ensured millions of Americans access to free screenings, tests, and preventive medications like PrEP. The case stems from a 2022 lawsuit by Texas employers citing religious objections to covering HIV prevention under their employee health plans. The legal question also targets the U.S. Preventive Services Task Force's authority, an independent panel determining mandatory preventive services, critiqued for its appointment process.

The 5th Circuit Court ruled partially in favor of the employers but limited the ruling to the involved Texas companies. The Biden administration has appealed to the Supreme Court to maintain the ACA coverage requirements. A ruling against the ACA provision could reverse years of expanded preventive care coverage, potentially reinstating outdated screening age recommendations and allowing insurers greater discretion to impose cost-sharing. Experts highlight that such changes might lead to a decline in preventive care utilization due to increased out-of-pocket costs.

Laurie Sobel from KFF notes that removing the free preventive services mandate could undermine patient incentives to seek care, compromising early detection and management of chronic diseases like heart disease and diabetes. Legal experts predict potential erosion of coverage and increased variability among insurers. Furthermore, concerns remain about the future role of the Preventive Services Task Force under the Department of Health and Human Services, especially given recent shifts in administrative policies.

The ACA's preventive care mandate has been linked to improved public health outcomes, including better cardiovascular health and early cancer detection. The case's outcome could have lasting impacts on insurance compliance, regulatory standards, and patient access to essential preventive health services nationwide. The Supreme Court's decision, expected in June, will shape the future landscape of health insurance coverage and preventive care in the United States.