Supreme Court Reviews ACA Preventive Services Mandate Impacting 150M Insured
The Affordable Care Act (ACA), established in 2010, has significantly expanded access to affordable and comprehensive health insurance for millions across the United States. Despite enduring over 2,000 legal challenges since its enactment, it has upheld pivotal provisions such as prohibiting discrimination based on pre-existing conditions and extending dependent coverage to age 26.
Currently, the ACA faces a critical Supreme Court case, Kennedy v. Braidwood Management, focused on a key provision requiring most private health plans to cover preventive services without cost-sharing. This mandate, outlined in Section 2713 of the ACA, obligates insurers to cover preventive services rated A or B by the US Preventive Services Task Force (USPSTF), along with vaccinations recommended by CDC's Advisory Committee on Immunization Practices (ACIP) and women’s and children’s health services endorsed by the Health Resources and Services Administration (HRSA).
These services include early cancer screenings, statins, folic acid, HIV pre-exposure prophylaxis (PrEP), and tobacco cessation aids, intended to promote public health and reduce long-term healthcare costs.
The legal challenge originates from Braidwood Management, a for-profit corporation objecting to covering PrEP due to religious beliefs, arguing that it encourages behavior they oppose. District Judge Reed O'Connor ruled in favor of Braidwood, declaring that USPSTF members were principal officers unconstitutionally appointed and blocking enforcement of USPSTF recommendations nationwide.
The Fifth Circuit Court affirmed the ruling but limited its scope to the plaintiffs only. The Biden administration has appealed to the Supreme Court, which during oral arguments appeared inclined to uphold the preventive services mandate, noting the Department of Health and Human Services (HHS) Secretary’s authority over USPSTF.
The decision, expected in June, will impact over 150 million Americans covered by private health insurance. A ruling against the mandate could reduce coverage for vital preventive services, likely decreasing utilization and adversely affecting public health outcomes. Even if the ACA is upheld, concerns remain regarding the potential influence of the current HHS Secretary over the USPSTF, ACIP, and HRSA, with implications for future preventive care recommendations. The case underscores ongoing tensions between legal interpretations of administrative appointments, religious liberty claims, and public health priorities, with significant consequences for insurance regulation and coverage in the U.S.