The U.S. Supreme Court will hear a challenge to the Affordable Care Act’s (ACA) preventive care provisions brought by individuals and small businesses citing religious objections to covering HIV prevention drugs and contraceptives, according to BestWire.
A ruling in favor of the plaintiffs could dismantle ACA provisions that provide more than 150 mn Americans with access to life-saving tests and treatments, according to the American Public Health Association.
The impact would extend beyond ACA marketplace plans to employer-sponsored and private health insurance.
The public health group warned that upholding the lower court’s ruling could lead to undetected diseases and inaccessible treatments, causing preventable illnesses, chronic conditions, and deaths.
In Braidwood Management Inc. v. Becerra, the court will examine whether the U.S. Preventive Services Task Force (PSTF) violated the Constitution’s Appointment Clause. The plaintiffs argue the PSTF exceeded its authority by issuing health coverage mandates as an unelected, unconfirmed body.
The 5th Circuit Court of Appeals partially agreed, finding PSTF’s mandate decisions unconstitutional but undecided on appropriate remedies.
While the court acknowledged the plaintiffs’ religious objections, it did not deem the mandates burdensome enough to overturn all ACA preventive care measures.
The Department of Justice argued that PSTF members fall outside the Appointment Clause, as they are “inferior officers” who can be appointed by a principal officer like Health and Human Services Secretary Xavier Becerra. The DOJ emphasized that the secretary’s authority to dismiss PSTF members supports this classification.
The government petitioned the Fifth Circuit’s ruling, hoping the Supreme Court would not find the USPSTF unconstitutional in determining coverage requirements through the ACA.
Under the court’s severability doctrine, it would seem they would uphold the role of the task force. But SCOTUS is not predictable and the trend toward curtailing the role of experts and the administrative state could win the day.
Epstein Becker Green healthcare attorney Richard Hughes IV in an email shared with Fierce Healthcare
Overturning of the Chevron deference in June is a flagship example of the nation’s top legal arbiters seemingly siding against federal agencies, and Republicans are hoping a series of recent decisions foreshadow future favorable rulings.
Another likely factor that will impact the case’s outcome is whether the government maintains its position in support of the USPSTF following the upcoming change in administration.
It’s possible the federal government will not remain in favor of the preventive services coverage requirement now that President-elect Donald Trump, a longtime opponent of the ACA, is retaking the White House.
Supreme Court justices will not determine whether the Department of Health and Human Services appropriately set guidelines for the Advisory Committee on Immunization Practices (ACIP) and the Health Resources and Services Administration (HRSA), though that issue was sent back to a lower court in June. Plaintiffs claimed the ACIP and the HRSA were not delegated the authority to set guidelines.
Venteur, an individual coverage health reimbursement arrangement (ICHRA) administrator, suggests there is opportunity for ICHRAs to “reimagine how preventive services are covered” if the Supreme Court rules against the government, the company said.
Skeptics of the ACA preventive services provision say these services are not truly free and ultimately lead to higher premiums for all Americans.
Your auto insurance doesn’t pay for oil changes. Prevention is positive, but it doesn’t fit the definition of insurance
Stacy Mays, founder and CEO of healthcare advisory firm Copeland Road Health Ventures
In October, the Biden administration proposed a rule requiring health plans to cover over-the-counter contraceptives for free, without cost sharing. The rule has not been finalized. Another proposed rule, which would have made it more difficult for health plans to claim a religious or moral exemption with regards to contraception, was rescinded by HHS in late December.