Supreme Court to Decide Fate of Free Preventive Care Under ACA: Becerra v. Braidwood Management
Constitutionality of No-Cost Services Challenged; Potential Impact on Healthcare Costs and Access for Millions
The United States Supreme Court announced just days ago that it will hear arguments on the constitutionality of one of the most celebrated provisions of the Affordable Care Act (ACA): the mandate for no-cost coverage of certain preventive care services. The case, Becerra v. Braidwood Management, Inc.; at issue is whether the U.S. Court of Appeals for the 5th Circuit erred in holding that the structure of the U.S. Preventive Services Task Force violates the Constitution's appointments clause and in declining to sever the statutory provision that it found to unduly insulate the task force from the Health & Human Services secretary’s supervision. The Supreme Court had upheld the ACA in previous challenges, though this challenge deals specifically with preventive services coverage.
While these care services are at no cost for insured patients, they do cost the providers, and the services are paid for by the ACA by the insurance companies, which has caused the price of insurance premiums to rise. As there is no “free” in things being free, someone, somewhere along the way, pays, and in this case it is the patients through higher premiums as this cost is passed through the insurance companies.
The heart of this legal challenge is the ACA's requirement that insurers cover preventive services without any cost-sharing for enrollees. These services include basic health interventions like cancer screenings, heart disease prevention medications such as statins, blood pressure medications, and HIV pre-exposure prophylaxis (PrEP). These services have saved lives by enabling early detection and treatment, reducing the financial burden on individuals, and potentially lowering overall healthcare costs by preventing more serious conditions.
The challenge against these mandates stems from a case where plaintiffs argue that the recommendations by the U.S. Preventive Services Task Force (USPSTF), which guide these coverage decisions, violate the Appointments Clause of the Constitution. The lower courts have had mixed responses; a federal judge in Texas struck down the mandates, but an appeals court limited the ruling's scope to only directly affect the plaintiffs involved. However, the broader implications of this legal debate could lead to a nationwide shift if the Supreme Court decides against the current mandates.
While the Supreme Court has largely weighed in favor of keeping the ACA intact, many worry that if a decision comes down that this part of the ACA is, in fact,, unconstitutional, many Americans with lower incomes will not get the preventative care that would help their health. These services have enabled lower-income individuals and families to get preventative screenings, vaccinations, and medications that they may not have been able to afford otherwise. While this may be true, creating this dynamic of no-cost services has led to increased costs on premiums, many of which are picked up by the U.S. taxpayer through premium subsidies. If these preventative health measures are eliminated, it may cause more costs to taxpayers as diseases are allowed to progress unnoticed, becoming more expensive in the long run, and, at least, in the lower income scale, will cause taxpayers to pick up the tab.
While the Supreme Court has agreed to hear the case, the exact timeline for a decision is unknown. Typically, cases accepted for review are heard in the term following the acceptance, which in this scenario would be the court's term starting in October 2025. Decisions are often handed down by the end of June, suggesting we might see a ruling sometime around June 2026.
Stay tuned to this Substack for updates on this critical issue.