In a pivotal decision with far-reaching implications for American healthcare, the U.S. Supreme Court on Friday upheld a key provision of the Affordable Care Act (ACA), ensuring that insurers must continue to cover a wide range of preventive services—including cancer screenings and HIV prevention medications—at no cost to patients.
The 6–3 ruling in Kennedy v. Braidwood Management, Inc. reversed a lower court’s decision that had threatened to dismantle the ACA’s preventive care mandate. Writing for the majority, Justice Brett Kavanaugh concluded that members of the U.S. Preventive Services Task Force (USPSTF), which recommends the services insurers must cover, are “inferior officers” under the Constitution and do not require Senate confirmation. He emphasized that the task force operates under the supervision of the Secretary of Health and Human Services (HHS), preserving constitutional accountability.
“The Task Force members are removable at will by the Secretary of HHS, and their recommendations are reviewable by the Secretary before they take effect,” Kavanaugh wrote, underscoring the chain of command that maintains executive oversight.
Justices Clarence Thomas, Samuel Alito, and Neil Gorsuch dissented, arguing that the USPSTF wields significant authority and should be subject to Senate confirmation.
Origins of the Case
The case stemmed from a lawsuit filed by several Christian individuals and two small businesses who objected to the ACA’s requirement that insurers cover pre-exposure prophylaxis (PrEP), a medication that prevents HIV infection. The plaintiffs argued that providing coverage for PrEP violated their religious beliefs, as they contended it could encourage behaviors they oppose, such as homosexual activity and intravenous drug use.
Beyond religious objections, the plaintiffs challenged the constitutionality of the USPSTF’s structure, asserting that its members, who are appointed by the HHS Secretary without Senate confirmation, held too much unaccountable power in determining mandatory health coverage.
In 2023, U.S. District Judge Reed O’Connor ruled in favor of the plaintiffs, declaring the USPSTF’s authority unconstitutional and invalidating all preventive-care coverage recommendations made since the ACA’s enactment in 2010. The Fifth Circuit Court of Appeals later affirmed the constitutional concerns but limited the ruling’s scope to the plaintiffs, setting the stage for the Supreme Court’s review.
Implications for Public Health
Friday’s decision preserves access to a broad spectrum of preventive services that have become integral to American healthcare. These services include screenings for various cancers, diabetes, and high blood pressure, as well as medications like statins and PrEP. The ruling ensures that these services remain available without co-pays or deductibles, a provision that public health advocates argue is crucial for early detection and prevention of serious illnesses.
Rick Pollack, President and CEO of the American Hospital Association, lauded the decision, stating, “Preventive services like breast cancer screenings, colonoscopies, and medications to treat high cholesterol and blood pressure save lives and make communities healthier.” He emphasized that the ruling upholds the importance of evidence-based medicine and ensures broader access to essential healthcare services.
A study by the Stanford Prevention Policy Modeling Lab highlighted the potential impact of the case, noting that nearly 40 million Americans utilize at least one of the preventive services mandated by the ACA. The Supreme Court’s decision averts a scenario where insurers could have imposed cost-sharing measures, potentially deterring individuals from seeking necessary preventive care.
Concerns Over Future Oversight
While the ruling maintains the current structure of preventive care coverage, it also underscores the significant authority vested in the HHS Secretary to oversee the USPSTF. This aspect has raised concerns among some public health experts about the potential for politicization of health recommendations.
Critics point to recent actions by HHS Secretary Robert F. Kennedy Jr., who has been accused of reshaping medical advisory panels to align with ideological perspectives. Notably, Kennedy dismissed all 17 members of the CDC’s vaccine advisory panel and replaced them with individuals, including vaccine skeptics, who subsequently issued recommendations against certain vaccines, contradicting established scientific consensus.
Health law analysts caution that similar interventions in the USPSTF could undermine the integrity of preventive care recommendations, potentially leading to decisions driven by ideology rather than scientific evidence.
A Continued Legal Battleground
The Supreme Court’s decision marks the fourth major challenge to the ACA since its enactment in 2010. Each time, the law has withstood legal scrutiny, reinforcing its role in the American healthcare system. However, the ongoing debates and legal challenges underscore the contentious nature of healthcare policy in the United States.
As the ACA continues to evolve, stakeholders from various sectors will closely monitor how administrative oversight influences the implementation of preventive care mandates. Ensuring that health policy remains grounded in scientific evidence and public health priorities will be essential to maintaining the trust and well-being of the American populace.
