Supreme Court Upholds ACA Preventive Services Coverage Including PrEP
The US Supreme Court, in a 6-3 ruling, upheld the Affordable Care Act's (ACA) mandate requiring private insurers to cover preventive services rated A or B by the US Preventive Services Task Force (USPSTF) without cost-sharing. This decision secures continued access to crucial HIV prevention tools, including pre-exposure prophylaxis (PrEP), as well as other essential preventive screenings for millions of Americans. The ruling, stemming from Kennedy v Braidwood Management, reinforces the bipartisan foundation of the ACA's focus on preventive health care, initially emphasized during the ACA's passage with broad support to cover services that prevent illness rather than solely treating it.
PrEP, which has since been given an A rating twice by the USPSTF, is now a critical element in HIV prevention covered under the ACA. The lawsuit challenging this mandate was rooted in ideological opposition based in Texas but could have jeopardized access to preventive services for approximately 150 million Americans if overturned. The ruling preserves existing preventive service coverage, but challenges remain regarding insurer compliance, especially as newer PrEP formulations such as long-acting injectables enter the market.
Despite federal guidance mandating coverage of all PrEP forms, reports indicate ongoing insurer barriers including prior authorization and cost-sharing requirements for some long-acting PrEP options. Cases of improper patient billing for components of preventive care, such as anesthesia during screenings, have also surfaced. Enforcement by state insurance commissioners and the Department of Labor is essential to ensure insurers adhere to ACA preventive service mandates and eliminate obstacles to access.
Looking ahead, maintaining equitable access to preventive care under the ACA's provisions involves addressing not only legal protections but also insurer practices that may hinder access. Efforts to educate stakeholders and improve compliance will be key as preventive health services continue to evolve, particularly in the field of HIV and hepatitis prevention. The ruling also has broader implications for sustaining public health programs amid proposed funding cuts and ongoing challenges such as stigma and provider bias.
Overall, the Supreme Court's decision provides clarity and stability to preventive health policy under the ACA, reinforcing the legal requirement for insurance coverage without cost-sharing for USPSTF-rated services. This outcome supports ongoing public health efforts to reduce disease transmission and improve health equity across insured populations.