Supreme Court Affirms ACA Provision on Preventive Services

On Friday, the Supreme Court upheld a significant component of the Affordable Care Act, mandating that health insurance providers cover certain preventive services at no cost. This ruling is seen as a win for health advocates, ensuring that many Americans can access cancer screenings, statins, and HIV prevention medications known as PrEP without out-of-pocket expenses.

Yet, there are concerns regarding the authority of the Department of Health and Human Services over a key advisory panel responsible for evaluating these preventive services. The court’s decision might allow more flexibility for Robert F. Kennedy Jr. in determining what services are covered.

The 6-3 ruling in the case of Kennedy v. Bladewood Management was authored by Judge Brett Kavanaugh, who was appointed by President Trump. This ruling raises questions about the independence and credibility of the U.S. Preventive Services Task Force, as noted by health experts.

“While this is a positive development for access to preventive care, it comes with costs,” remarked Josh Salomon, a health policy professor at Stanford. “The task force’s reliability and independence are crucial for people to trust its recommendations.”

The task force’s mission is to assess whether preventive health measures can benefit patients. To achieve this, they typically conduct statistical analyses to evaluate the best scientific evidence available and determine the effectiveness of various interventions.

Following their evaluations, the task force issues recommendations graded A to D, with A and B indicating positive outcomes, while some recommendations may conclude that evidence is insufficient.

Under the ACA, insurers are obliged to cover services deemed A or B by the task force without charging patients.

A coalition of conservative Christian employers from Texas, represented by Braidwood Management, challenged the task force’s decisions, arguing that its authority over national health policies breached constitutional appointment clauses. They were particularly against covering PrEP, claiming such coverage infringed on their religious freedoms. The Supreme Court primarily assessed whether the ACA’s provisions were in conflict with these constitutional aspects.

The appointment clause delineates two categories of executive officers appointed by the President, along with those appointed by their subordinates. Significant decisions regarding health insurance policies must stem from either principal or inferior officers, who ideally are held democratically accountable. Braidwood contended that none of the task force members fit these criteria, rendering their recommendations unconstitutional.

The government countered that HHS officials appoint task force members and that the secretary of HHS can reject their recommendations. The Supreme Court sided with the government, affirming that the HHS Secretary has authority over the task force’s recommendations.

As a result, Kennedy may have the power to dismiss recommendations he disagrees with, which could potentially open the door for insurers to avoid covering certain services altogether. There’s concern that this new task force might also alter or dismiss previous recommendations.

Public health could suffer because of this. For instance, Yale epidemiologists have warned that eliminating cost-free access to PrEP could lead to substantially more new HIV infections—about 20,000 over the next five years.

“Even a small cost share can deter individuals from seeking needed healthcare,” stated Eric Waskowicz, senior policy manager at a health policy agency.

This ruling also allows Kennedy the potential to overhaul the task force completely, similar to actions he took with another advisory committee in June, where he replaced all members of the Advisory Committee on Vaccination Practices.

If he were to take similar steps with the preventive services task force, experts warn it could damage the public and scientific communities’ trust in the task force and its guidance.

“This situation relies heavily on our faith that the task force can provide answers to vital, evidence-based health questions,” Salomon added. “The way ACIP members were replaced shows what happens when scientific panels become influenced by political agendas.”

Jennifer Nu, a constitutional law professor at the University of Chicago, noted that the Supreme Court has increasingly viewed structural independence as a liability when it exists outside presidential control.

While there are mechanisms for maintaining independence, such as the historical norms that protect various commissions, those norms appear to be under threat. As health and scientific governance evolves, there’s a risk that politicizing healthcare will ultimately alienate populations rather than support their health needs.