Potential Loss of No-Cost Preventive Services Looms as Supreme Court Reviews ACA Ruling

A recent investigation by the Stanford Prevention Policy Modeling Lab (PPML) highlights that approximately 30% of individuals with private health insurance in the United States--nearly 40 million people--utilize at least one of the preventive health services provided at no cost under the Affordable Care Act (ACA).

However, these services face jeopardy due to an ongoing legal challenge. On April 21, the Supreme Court is set to hear arguments in the case of Kennedy v. Braidwood Management Inc., which will address the constitutionality of the ACA's preventive services mandate as ruled by a Texas district court.

The ACA mandates that private insurers cover certain preventive services at no expense to patients. These services include screenings and tests for conditions such as high blood pressure, diabetes, cholesterol, cancer, HIV, and hepatitis C. A portion of these mandated services is based on recommendations from the U.S. Preventive Services Task Force (USPSTF), which evaluates the effectiveness of interventions aimed at prevention and early disease detection. The current case focuses on the legality of requiring coverage for USPSTF-recommended services.

The research conducted by the PPML team, in collaboration with Harvard T.H. Chan School of Public Health, analyzed claims data from privately insured individuals across the United States. The findings indicate that nearly 30% of those with private insurance, and nearly half of privately insured women, utilize at least one of the ten services potentially affected by the Braidwood case. The study identifies 13 states where at least one million residents benefit from these free services, including Texas, where the case originated, which has about 3 million recipients.

Experts emphasize the significance of preventive services in healthcare. They warn that removing guaranteed access to these services could result in decreased utilization of essential screenings and treatments, ultimately leading to poorer health outcomes.

According to prior research, around 150 million individuals in the U.S. hold employer-sponsored insurance, qualifying them for the free services mandated by the ACA. The Stanford study represents the most comprehensive evaluation conducted to date concerning the implications of the Braidwood decision, encompassing a wide range of threatened services and examining their utilization without cost-sharing.

A crucial element of the Supreme Court's deliberation will involve assessing the argument that the mandated coverage of USPSTF-recommended services infringes upon the Appointments Clause of the Constitution, which stipulates that federal officers must be appointed by the President and confirmed by the Senate. The health experts on the USPSTF are not presidential appointees.

Furthermore, the original case from Texas claimed that the federal requirement to cover HIV prevention medication violated the plaintiffs' religious rights.

The Stanford study focused on a group of 16.1 million enrollees in employer-sponsored health insurance, representing a national total of 130.9 million. It highlighted the preventive services that are most likely to be impacted by the Braidwood ruling due to having new or revised USPSTF recommendations since the ACA's enactment. These services encompass statin therapy for cardiovascular disease prevention, HIV pre-exposure prophylaxis, breast cancer risk reduction medications, and new or expanded screenings for various cancers and infections.

The researchers noted that the ACA's preventive services mandate enjoys significant public support, as evidenced by numerous opinion polls. The implications of the Supreme Court's decision will be profound for millions of individuals with private insurance across the country who currently benefit from the ACA's preventive services mandate.

In summary, the stakes are high as the Supreme Court prepares to deliberate on a ruling that could impact access to essential preventive health services for millions of Americans.