Introduction to the Supreme Court Case
The Supreme Court on Monday is set to hear arguments in a case challenging a provision of the Affordable Care Act that requires private insurers to cover health care screenings, tests and checkups for free.
Experts say the court’s ruling in the case, called Kennedy v. Braidwood Management, could have sweeping consequences for patient access to preventive health care across the United States.
Background of the Affordable Care Act
Since the ACA was passed in 2010, most insurers have had to cover a wide range of prevention services at no cost to patients — including cancer screenings, mammograms, statins for heart disease and HIV prevention medications. About 150 million people are currently enrolled in private health insurance plans that cover free prevention services, according to KFF, a nonpartisan group that researches health policy issues. A KFF analysis found that 1 in 20 people — about 10 million people — received at least one prevention service in 2019.
Importance of the Case
“This is a really crucial case,” said Arthur Caplan, the head of the division of medical ethics at NYU Langone Medical Center in New York City, noting that many Americans say they can’t afford the high out-of-pocket cost of medical care. “The price will be paid in dead bodies if the court rules against.”
The Lawsuit
The lawsuit was filed in 2022 by a group of conservative Christian employers in Texas. They argued that the ACA rule requiring them to cover the HIV prevention pill PrEP in their employee health plans violated their religious rights. They also challenged the U.S. Preventive Services Task Force — an independent panel that recommends which preventive services insurers must cover — calling it unconstitutional because its members aren’t appointed by the president or confirmed by Congress.
Previous Court Rulings
Last year, the 5th U.S. Circuit Court of Appeals sided with the employers, but limited the decision to just the eight Texas companies involved in the case. The court declined to make the ruling apply nationwide. The federal government, under the Biden administration, appealed the case to the Supreme Court. The Trump administration then told the court in February that it intended to defend the requirement.
What Happens if the Supreme Court Rules Against?
The Supreme Court is expected to make a decision sometime in June. If the court strikes down the ACA rule, it would mean insurers could deny coverage for preventive services recommended by the task force, said Laurie Sobel, an associate director for women’s health policy at KFF. “The recommendations would go back to March 2010,” Sobel said, referring to the year the ACA was enacted. Notable changes, she added, could include the starting age that most insurers cover colorectal cancer screens as well as coverage of PrEP.
Potential Consequences
If the free preventive services requirement goes away, Richard Hughes, a health care attorney for Epstein Becker Green and lead counsel for the HIV+Hepatitis Policy Institute, said coverage could vary by insurance company. “I think you’ll see some gradual erosion across the board,” Hughes said, referring to the services that insurers cover. “I think you’re going to see some restriction of access, you’re going to see cost sharing applied to certain services, and that’s been shown to be a barrier, because people are more inclined to walk away from a service when they’re presented with an out-of-pocket cost.”
Impact on Public Health
Chronic conditions such as heart disease, cancer and diabetes are the leading causes of death and illness in the United States, according to the Centers for Disease Control and Prevention. A 2024 report from the Center for American Progress found the ACA rule has been linked to more Americans with better blood pressure, blood sugar levels and overall heart health. Other studies suggest it increased early-stage cancer diagnosis.
Conclusion
The Supreme Court’s decision on the Kennedy v. Braidwood Management case will have significant implications for the health care system in the United States. If the court rules against the ACA rule, it could lead to a reduction in preventive care services, ultimately affecting the health and well-being of millions of Americans.
FAQs
- Q: What is the Kennedy v. Braidwood Management case about?
A: The case challenges a provision of the Affordable Care Act that requires private insurers to cover health care screenings, tests, and checkups for free. - Q: What are the potential consequences if the Supreme Court rules against the ACA rule?
A: If the court strikes down the ACA rule, insurers could deny coverage for preventive services, leading to reduced access to care and potentially worsening health outcomes. - Q: How many people are currently enrolled in private health insurance plans that cover free prevention services?
A: About 150 million people are currently enrolled in such plans, according to KFF. - Q: What is the U.S. Preventive Services Task Force, and what role does it play in the case?
A: The task force is an independent panel that recommends which preventive services insurers must cover. The plaintiffs in the case argue that the task force is unconstitutional because its members are not appointed by the president or confirmed by Congress.
