The Supreme Court has issued its long-anticipated ruling in Braidwood Management v. Becerra, affirming the constitutionality of the Affordable Care Act provision that requires insurers to cover certain preventive services recommended by the U.S. Preventive Services Task Force without cost-sharing. This includes cancer screenings, pregnancy care and testing for sexually transmitted diseases.
Several Texas residents and two Christian-affiliated businesses had sued the government, arguing that the provision violates the appointments clause, which requires that officers of the U.S. only be appointed by the president with advice and consent of the Senate. Members of USPSTF were not nominated by the president and approved by the Senate. They also argued that covering benefits like preexposure prophylaxis (PrEP), which is used to prevent HIV, goes against their religious beliefs, violating the Religious Freedom Restoration Act (RFRA).
In a 6-3 ruling authored by Justice Brett Kavanaugh, the Supreme Court stated that the U.S. Preventive Services Task Force are inferior officers and don’t require Senate approval, and therefore, their appointment was constitutional under the appointments clause. HHS Secretary Robert F. Kennedy Jr. has the power to appoint and fire members of the task force, and review and block their recommendations. Justices Clarence Thomas, Samuel Alito and Neil Gorsuch dissented.
In regards to the religious claim, the district court ruled in favor of Braidwood. The Supreme Court noted that the government did not appeal this part of the district court’s judgment, so the religious issue remains with the district court, said Daniel Frier, a healthcare attorney and founding partner of Frier Levitt.
“The Court’s handling of the religious freedom claim signals that employers with sincerely held religious objections may still seek exemptions from certain coverage mandates under RFRA. The ongoing proceedings in the district court on this issue could influence the scope of religious accommodations available under federal health care law,” he added.
Had the Supreme Court decided differently on the appointments clause, the government’s ability to require insurers and employers to cover preventive services without cost sharing could have been severely limited.
An executive from the American Cancer Society Cancer Action Network applauded the decision.
“In a critical ruling that helps reduce the cancer burden nationwide by ensuring affordable access to evidence-based cancer screening and preventive services, we are pleased that today the Supreme Court upheld the provision of the Affordable Care Act that requires most private insurers to cover many lifesaving preventive care services without cost sharing. Research has shown that any out-of-pocket costs can be a deterrent to accessing proven cancer screening, which can be the difference between life and death,” said Lisa Lacasse, president of the American Cancer Society Cancer Action Network, in a statement.
Families USA, an advocacy group for healthcare consumers, said the decision provides some security to more than 170 million Americans by preserving their access to preventive services without cost-sharing.
Still, there’s cause for concern, said Anthony Wright, executive director of Families USA.
“While this is a foundational victory for patients, patients have reason to be concerned that the decision reaffirms the ability of the HHS secretary, including our current one, to control the membership and recommendations of the US Preventive Services Task Force that determines which preventive services are covered,” Wright said in a statement. “We must be vigilant to ensure Secretary Kennedy does not undo coverage of preventive services by taking actions such as his recent firing of qualified health experts from the CDC’s independent vaccine advisory committee and replacing them with his personal allies.”
Another healthcare expert noted that the “implications of this case cannot be overstated.” However, this doesn’t mark the final chapter.
“The decision does not resolve the deeper legal and political uncertainty surrounding health care access,” said Greg Fosheim, a partner at McDermott Will & Emery. “Braidwood must be read in tandem with the Court’s recent decision in United States v. Skrmetti, which limited federal protections for access to gender-affirming care. Taken together, these rulings underscore how vulnerable many forms of essential, compassionate, and evidence-based health care remain — particularly when they intersect with contested social or religious issues.”
Fosheim emphasized that in Braidwood, the Court left open the possibility of future exemptions based on religious freedoms for services like PrEP. This suggests that “even when structural elements of the ACA are upheld, access to comprehensive care can still be narrowed in practice,” he said.
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