Supreme Court Upholds ACA Preventive Services Process but Signals Future Changes

The U.S. Supreme Court ruling in Kennedy v. Braidwood upheld the constitutional process underlying the Affordable Care Act's (ACA) preventive services benefits package, specifically preserving the selection method of members of the U.S. Preventive Services Task Force (USPSTF). The decision affirmed that USPSTF members do not require Senate confirmation, as they serve at the will of the Department of Health and Human Services (HHS) Secretary. This preservation maintains the current ACA requirement for non-grandfathered group health plans and self-insured employer plans to cover preventive services without patient cost-sharing, including checkups and cancer screenings.

Currently, the HHS Secretary has authority over USPSTF membership, which can affect the selection of covered preventive services. The new administration has replaced members of advisory committees, triggering ongoing scrutiny and litigation related to vaccine advisory recommendations and preventive services guidelines. These cases could influence future changes to ACA preventive benefits requirements.

Employers and their benefits advisors should closely monitor potential shifts in preventive services coverage mandates, especially as changes in USPSTF composition or outcomes of litigation concerning advisory committees may alter the required benefits. Changes in the preventive services package could present opportunities for cost-saving by reducing coverage requirements but may also challenge employers who seek benefit stability.

The preventive services package plays a crucial role in conjunction with high-deductible health plans (HDHPs) and health savings accounts (HSAs), as a more comprehensive preventive benefits package can offset costs for patients under HDHPs by reducing out-of-pocket expenses before deductibles are met. Therefore, any narrowing of the preventive services coverage may affect employer health plan design strategies.

In summary, while the Supreme Court ruling currently supports the status quo in ACA preventive services coverage, ongoing regulatory shifts and litigation indicate a dynamic environment requiring vigilance from employers and insurance professionals.