In Oral Arguments, Supreme Court Seems to Side with ACA Preventive Care Rule
Based on oral arguments that took place on April 21, news media outlets are reporting that there is some probability that the U.S. Supreme Court will rule in favor of preventive care rules under the Affordable Care Act (ACA). As the Associated Press’s Lindsay Whitehurst wrote on Monday afternoon, “The Supreme Court seemed likely to uphold a key preventive-care provision of the Affordable Care Act in a case heard Monday. Conservative justices Brett Kavanaugh and Amy Coney Barrett, along with the court’s three liberals, appeared skeptical of arguments that Obamacare’s process for deciding which services must be fully covered by private insurance is unconstitutional,” she wrote. The case in question is Braidwood Management, Inc. v. Becerra.
Further, Whitehurst wrote, “The case could have big ramifications for the law’s preventive care coverage requirements for an estimated 150 million Americans. Medications and services that could be affected include statins to prevent heart disease, lung cancer screenings, HIV-prevention drugs and medication to lower the chance of breast cancer for high-risk women. The plaintiffs argued that requirements to cover those medications and services are unconstitutional because a volunteer board of medical experts that recommended them should have been Senate- approved. The challengers have also raised religious and procedural objections to some requirements.” And, she added, “The Trump administration defended the mandate before the court, though President Donald Trump has been a critic of the law. The Justice Department said board members don’t need Senate approval because they can be removed by the health and human services secretary.”
Meanwhile, legal expert Amy Howe wrote on Monday evening in SCOTUSblog that “The Supreme Court on Monday appeared to side with the federal government in a dispute over the constitutionality of the structure of a task force within the Department of Health and Human Services. The case came to court as a dispute over a 2019 decision by the group, known as the U.S. Preventive Services Task Force, to recommend PrEP, the HIV-preventative medications, for coverage as a “preventative health service” at no cost to patients. The challengers in the case contend that the group’s recommendations are invalid because the members of the task force were not appointed by the president and confirmed by the Senate, but most of the justices seemed skeptical of that argument.”
Howe noted that “The Affordable Care Act of 2010 requires private health insurers to cover “preventive health services” at no additional cost to patients. But the law does not indicate what those services are. Instead, the law directs the task force to make that determination, and it requires its recommendations to be ‘independent, and to the extent practicable, not subject to political pressure.’”
What’s more, she wrote, “The dispute before the court on Monday began in 2020, when four individuals and two small businesses went to federal court in Texas to challenge the requirement that insurers cover pre-exposure prophylaxis medicines, known as PrEP, which are highly effective at preventing HIV. The task force had recommended in June 2019 that PrEP be included as a mandatory preventive-care service. The plaintiffs object to the requirement to provide PrEP on religious grounds, because they believe that it will encourage same-sex relationships and intravenous drug use. They contend that the structure of the task force violates the Constitution’s appointments clause, which requires ‘principal officers’ of the United States to be appointed by the president and confirmed by the Senate.”
An analysis of the underlying case appeared on Dec. 23, 2024, in the Forefront section of Health Affairs. In it, Andrew Twinamatsiko, Zachary Baron, and Sheela Ranganathan explained that “The government is asking the Supreme Court to decide whether the structure of the US Preventive Services Task Force (the “Task Force”)—a group of nationally recognized experts who recommend services that virtually all private insurers must cover for free—is constitutional. The parties on the other side of the case (the challengers), dissatisfied with part of the trial court’s decision, are also asking the Supreme Court to invalidate the required coverage of all the preventive services without cost-sharing. (emphasis added). They fault the lower court for ruling that Congress appropriately delegated authority to various agencies within the U.S. Department of Health and Human Services (HHS) to recommend evidence-based services that insurers must cover.
The authors noted that “The stakes in this case couldn’t be any higher. The requirement that certain preventive services be covered without cost-sharing is one of the most popular provisions of the ACA. It has enabled over 150 million people to access free preventive care, which has improved overall health outcomes and minimized gaps in access to care, especially among marginalized populations. Ending this requirement would roll back health care to the pre-ACA era when cost-sharing barriers made it harder for many Americans to access preventive services. We have covered this litigation’s background and the different turns the case has taken in various Health Affairs Forefront articles. This article summarizes the government’s reasons for asking the Supreme Court to intervene and the challengers’ nondelegation argument.”
