Supreme Court Ruling Preserves Access to Preventive Services

Health advocates welcomed a US Supreme Court decision announced Friday that preserves a federal mandate for insurers to cover, without copays, certain preventive medical tests and treatments.

The Supreme Court split 6-3 in the decision announced Friday. 

While the court ruling was seen largely as a win for medical and consumer groups, some voiced concerns about its impact on the Health and Human Services (HHS) Secretary’s power over an influential panel, the US Preventive Services Task Force (USPSTF).

Anthony Wright, executive director of the consumer advocacy group Families USA, said the Supreme Court ruling beat back “yet another challenge” to the Affordable Care Act (ACA) and was a win in terms of guaranteeing more access to care.

“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. 

Religious Objection to HIV Prevention Treatment

The case stems from a complaint filed by Braidwood Management, a Christian-owned firm objecting to how a provision of the 2010 ACA has been implemented. The Texas firm wanted to exclude coverage of pre-exposure prophylaxis for HIV and other preventive health services for religious objections. 

The ACA requires coverage without copay for tests and treatments that get “A” and “B” ratings from the USPSTF. 

The USPSTF has issued recommendations with these top marks for more than 40 tests and treatments, noted Justice Brett Kavanaugh in the majority opinion in this case. 

Services with current “A” and “B” ratings from USPSTF include cancer and diabetes screenings, nicotine patches for adults trying to quit smoking, statin medications to reduce the risk of heart disease and stroke, and physical therapy to help the elderly avoid falls, he wrote.

Major Medical Groups Applaud Ruling

The American Medical Association, the American Academy of Family Physicians, the American Cancer Society, and about 30 other patient and medical professional organizations applauded the Supreme Court decision in a joint statement Friday.

In February, these groups had filed a brief with the Supreme Court, arguing in favor of the mandate.

In it, these groups said almost 152 million people in the US were able to get access to preventive services without cost sharing in 2020 due to the mandate. Reducing insurance coverage for preventive services would “lead to worsening patient outcomes, resulting in preventable deaths, and creating higher long-term medical costs,” said the groups in the brief.

The key question before the Supreme Court in this case focused on the view of authority of the USPSTF. 

In the majority opinion, Kavanaugh said the plaintiffs sought to portray the USPSTF as an independent agency wielding “unchecked power in making preventive-services recommendations of great consequence for the healthcare and health-insurance industries and the American people more broadly.”

In fact, those challenging the ACA mandate asserted that, with respect to

preventive-services recommendations, the Task Force members were “more powerful” than even the US president or the secretary of the HHS, Kavanaugh wrote.

That’s not the case, Kavanaugh wrote in the majority opinion.

Instead, the USPSTF members serve at the will of the secretary of the HHS, who can remove them, Kavanaugh noted. In addition, federal law allows the HHS secretary to directly review and block USPSTF recommendations before they take effect, Kavanaugh wrote.

Some Reservations

Family USA’s Wright noted how HHS Secretary Robert Kennedy Jr recently replaced members of the CDC’s independent vaccine advisory committee as an example of his concerns.

The American Gastroenterological Association called the Supreme Court ruling “positive news for patient care protections.”

“The ruling reiterates the authority that HHS has over the task force and its decisions, and we remain vigilant considering the secretary’s recent actions to other expert panels,” the AGA said Friday in a statement. “We will continue to work with our coalition partners and champions to ensure patients continue to have coverage of essential preventive screenings.”

The ACA mandate also has helped make cancer screening more palatable to younger patients, which physicians note is especially important given that more cases seem to be occurring earlier in life. National Institutes of Health researchers recently reported that the incidence of 14 cancer types increased among people under age 50 between 2010 and 2019. 

“To convince healthy people to undergo a test when they’re feeling fine to prevent a cancer that might or might not develop years in the future, it requires reducing barriers and taking away copays and providing insurance coverage,” Jatin Roper, MD, an assistant professor of medicine at Duke University and AGA spokesman, told Medscape in recent interview.

Roper reported no relevant financial disclosures. 

Kerry Dooley Young is a freelance journalist based in Washington, DC. She has covered medical research and healthcare policy for more than 20 years.