Supreme Court upholds ACA preventive care

In a 6-3 decision, the Supreme Court upheld a key Affordable Care Act provision requiring health insurers to cover certain recommended preventive services cost-free.

Reminder: The U.S. Preventive Services Task Force (USPSTF), an expert panel, evaluates preventive services and recommends which should be provided at no cost.

• Why it’s important: Services currently required to be covered at no cost include certain mental health screenings, drug/alcohol screenings, PrEP for HIV, etc.
• A group of conservative Christian employers in Texas led a lawsuit challenging the requirement. They argued that having the independent panel determine national health coverage violated the appointments clause of the Constitution and that covering PrEP violated religious freedom (though the Supreme Court only weighed in on the appointments clause argument).

The details:

• The employers argued that USPSTF members were not appointed as either of two types of executive branch officers that the Constitution allows to make certain national policy decisions. They argued that the task force recommendations requiring them to cover certain preventive services in their employer-sponsored health plans were unconstitutional because task force members are not confirmed by the Senate.
• The government defended the task force, arguing that it is constitutional because HHS officials appoint USPSTF members, and the HHS secretary can remove members at will and veto recommendations.
• The Supreme Court agreed with the government and affirmed that the HHS secretary has these powers over USPSTF and its recommendations.

The bigger context:

• The decision is a win for health advocates, who wanted to maintain the no-cost coverage requirement for preventive services. Providing preventive services at no cost is key to increasing access to and receipt of important screenings and other preventive services. Decreasing access to such services would lead to worse health outcomes.
• But: The ruling could challenge USPSTF’s independence and credibility. It cements a strong role for the HHS secretary in overseeing the USPSTF, including removing members and modifying its rulings. This paves the way for HHS Secretary Kennedy to reject recommendations he disagrees with, allowing insurers to charge for those services or avoid covering them in some cases. It also opens the door for Kennedy to remove all the task force members and appoint new people, and a new task force could reject previous recommendations.

Read more: Supreme Court rejects challenge to free preventive care, bolsters RFK Jr.’s power; SCOTUS upholds Obamacare free preventive care coverage