The Supreme Court is set to hear arguments on Monday, April 21, 2025, in a pivotal case that could jeopardize the no-cost preventive care guarantees established under the Affordable Care Act (ACA), commonly known as ObamaCare. The case, titled Kennedy v. Braidwood, involves a challenge from Christian-owned businesses and six individuals in Texas who argue that the ACA's requirement for insurers to cover preventive services without cost-sharing is unconstitutional.
At the heart of this legal battle is the U.S. Preventive Services Task Force (USPSTF), an independent panel that recommends preventive health services such as cancer screenings, immunizations, and tobacco cessation programs. Under the ACA, health insurers are mandated to cover these services without any cost to patients, benefiting over 150 million Americans each year. However, the plaintiffs contend that the structure of the USPSTF violates the U.S. Constitution's Appointments Clause, which stipulates that federal officers must be appointed by the president and confirmed by the Senate.
“If costs are reintroduced, people just don’t seek care,” said Eric Waskowicz, senior state policy manager at the advocacy group United States of Care. He emphasized the importance of maintaining no-cost preventive care, particularly for individuals with limited means. The implications of this case are vast, as reinstating cost-sharing could deter patients from seeking necessary preventive services.
The legal challenges began in 2022 when a group of conservative Texas employers and individuals filed a lawsuit against the coverage requirement. Initially, a district court judge sided with the plaintiffs, invalidating the entire USPSTF. However, the 5th U.S. Circuit Court of Appeals later limited its ruling to just the eight Texas companies involved in the case, allowing the Biden administration to appeal the decision.
In a surprising twist, the Trump administration announced earlier this year that it would continue to defend the ACA. Legal experts have noted that the Justice Department’s arguments suggest a desire to give the Secretary of Health and Human Services (HHS), Robert F. Kennedy Jr., greater control over the independent task force. This raises concerns about whether HHS will adhere to scientific recommendations or impose its own agenda.
Andrew Pincus, a partner at Mayer Brown LLP, who filed a brief on behalf of the American Public Health Association, stated, “Even if the court upholds the task force’s constitutionality, the question will then be, will HHS follow the science and uphold the USPSTF recommendations, or will it take a different course?” This uncertainty has public health advocates on high alert.
The Supreme Court's ruling, expected in June 2025, could have far-reaching consequences for preventive care coverage. The case not only questions the constitutionality of the USPSTF but also the legality of the ACA's requirement for all insurers to cover preventive services recommended by the task force since the law's inception in 2010.
Katherine Hempstead, PhD, senior policy officer at the Robert Wood Johnson Foundation, expressed grave concerns about the potential fallout. “Evidence-based preventive care saves lives and improves quality of life,” she noted, warning that if access to no-cost preventive care is compromised, the nation could see an increase in preventable illnesses and deaths.
Among the services at risk are critical screenings for conditions such as lung cancer, colorectal cancer, and diabetes, as well as preventive treatments like PrEP for HIV. Hempstead highlighted that losing access to these services at no cost could effectively revert the healthcare system back to a time before the ACA, where many preventive measures were not covered.
Dorianne Mason, director of health equity at the National Women's Law Center, echoed these sentiments, stating, “Make no mistake: those who want to end the preventive services requirement are coming for it all.” She emphasized that a ruling against the coverage mandate would disproportionately harm women and families, leading to broader public health implications.
Dr. Georges Benjamin, executive director of the American Public Health Association, warned that a negative ruling could result in more cases of cancer, heart disease, and other preventable conditions. “This means more cancer, more heart disease, more strokes, more complications for pregnancy, more drug misuse and, frankly, more preventable deaths,” he said.
The potential loss of coverage extends to essential services for infants and mothers, including vaccines for respiratory syncytial virus (RSV), COVID-19, and screenings for maternal health issues. The implications of this case are profound, as public health experts argue that preventive care is crucial in reducing healthcare costs in the long run.
As the Supreme Court prepares to hear arguments, all eyes are on the justices and the broader implications of their decision. The outcome of Kennedy v. Braidwood could reshape the landscape of preventive health services in the United States, impacting millions of Americans who rely on no-cost coverage for essential health services.
With the stakes so high, advocates for public health are urging the court to uphold the ACA's preventive services requirement, emphasizing that access to these services is vital for maintaining the health and well-being of the population. As the date approaches, discussions surrounding the case continue to intensify, reflecting the deep divide over healthcare policy in the nation.
