An Uncertain Future for No-Cost Preventive Care

Later this month, the U.S. Supreme Court is anticipated to announce its decision in Kennedy vs. Braidwood Management, a case that could significantly impact the no-cost coverage of preventive healthcare services under the Patient Protection and Affordable Care Act (ACA). At the center of the case is whether the structure of the U.S. Preventive Services Task Force (USPSTF) – an independent body convened by the federal government that makes recommendations for preventive services that nearly all private insurances must cover without cost sharing under provisions of the ACA (specifically, Grade A and B recommendations) – violates the Appointments Clause of the U.S. Constitution. This clause states that “officers of the United States” may only be appointed by the president with the Senate’s approval.

The case, initiated in 2022 by a self-insured, Christian-owned business, specifically targeted the coverage of pre-exposure prophylaxis (PrEP) for preventing HIV in high-risk individuals. However, the decision could broadly affect the coverage of other preventive services, including colorectal cancer screening tests. In June 2024, the 5th Circuit Court of Appeals upheld a district court’s ruling that the ACA’s requirement to cover without cost-sharing services recommended by USPSTF is unconstitutional, paving the way for the current Supreme Court showdown.

The consequences of this ruling could be significant. If the Court rules in favor of Braidwood, private health insurers would no longer be required to cover, without cost-sharing, preventive services recommended by USPSTF after March 2010 when the ACA was enacted. This would likely reverse the progress we have made in increasing colorectal cancer screening rates by reducing financial barriers to care. Interestingly, despite a new administration, the federal government continues to advocate for upholding the law, asserting that USPSTF members are “inferior officers” such that the Secretary of Health and Human Services can dismiss individual members and oversee or veto the Task Force’s recommendations at will, potentially threatening scientific independence. Though it’s often challenging to predict the Supreme Court’s final decision, the tone of questioning during oral arguments in April hinted at a possible win for the ACA and preventive care. Stay tuned, as the decision to be released later this month has seismic clinical implications.

Megan A. Adams, MD, JD, MSc

Editor in Chief

Later this month, the U.S. Supreme Court is anticipated to announce its decision in Kennedy vs. Braidwood Management, a case that could significantly impact the no-cost coverage of preventive healthcare services under the Patient Protection and Affordable Care Act (ACA). At the center of the case is whether the structure of the U.S. Preventive Services Task Force (USPSTF) – an independent body convened by the federal government that makes recommendations for preventive services that nearly all private insurances must cover without cost sharing under provisions of the ACA (specifically, Grade A and B recommendations) – violates the Appointments Clause of the U.S. Constitution. This clause states that “officers of the United States” may only be appointed by the president with the Senate’s approval.

The case, initiated in 2022 by a self-insured, Christian-owned business, specifically targeted the coverage of pre-exposure prophylaxis (PrEP) for preventing HIV in high-risk individuals. However, the decision could broadly affect the coverage of other preventive services, including colorectal cancer screening tests. In June 2024, the 5th Circuit Court of Appeals upheld a district court’s ruling that the ACA’s requirement to cover without cost-sharing services recommended by USPSTF is unconstitutional, paving the way for the current Supreme Court showdown.

The consequences of this ruling could be significant. If the Court rules in favor of Braidwood, private health insurers would no longer be required to cover, without cost-sharing, preventive services recommended by USPSTF after March 2010 when the ACA was enacted. This would likely reverse the progress we have made in increasing colorectal cancer screening rates by reducing financial barriers to care. Interestingly, despite a new administration, the federal government continues to advocate for upholding the law, asserting that USPSTF members are “inferior officers” such that the Secretary of Health and Human Services can dismiss individual members and oversee or veto the Task Force’s recommendations at will, potentially threatening scientific independence. Though it’s often challenging to predict the Supreme Court’s final decision, the tone of questioning during oral arguments in April hinted at a possible win for the ACA and preventive care. Stay tuned, as the decision to be released later this month has seismic clinical implications.

Megan A. Adams, MD, JD, MSc

Editor in Chief

Later this month, the U.S. Supreme Court is anticipated to announce its decision in Kennedy vs. Braidwood Management, a case that could significantly impact the no-cost coverage of preventive healthcare services under the Patient Protection and Affordable Care Act (ACA). At the center of the case is whether the structure of the U.S. Preventive Services Task Force (USPSTF) – an independent body convened by the federal government that makes recommendations for preventive services that nearly all private insurances must cover without cost sharing under provisions of the ACA (specifically, Grade A and B recommendations) – violates the Appointments Clause of the U.S. Constitution. This clause states that “officers of the United States” may only be appointed by the president with the Senate’s approval.

The case, initiated in 2022 by a self-insured, Christian-owned business, specifically targeted the coverage of pre-exposure prophylaxis (PrEP) for preventing HIV in high-risk individuals. However, the decision could broadly affect the coverage of other preventive services, including colorectal cancer screening tests. In June 2024, the 5th Circuit Court of Appeals upheld a district court’s ruling that the ACA’s requirement to cover without cost-sharing services recommended by USPSTF is unconstitutional, paving the way for the current Supreme Court showdown.

The consequences of this ruling could be significant. If the Court rules in favor of Braidwood, private health insurers would no longer be required to cover, without cost-sharing, preventive services recommended by USPSTF after March 2010 when the ACA was enacted. This would likely reverse the progress we have made in increasing colorectal cancer screening rates by reducing financial barriers to care. Interestingly, despite a new administration, the federal government continues to advocate for upholding the law, asserting that USPSTF members are “inferior officers” such that the Secretary of Health and Human Services can dismiss individual members and oversee or veto the Task Force’s recommendations at will, potentially threatening scientific independence. Though it’s often challenging to predict the Supreme Court’s final decision, the tone of questioning during oral arguments in April hinted at a possible win for the ACA and preventive care. Stay tuned, as the decision to be released later this month has seismic clinical implications.

Megan A. Adams, MD, JD, MSc

Editor in Chief