ACOI Advocates to Protect Preventative Care

The ACOI has joined the American Cancer Society, American Medical Association and 30 other patient organizations and medical societies in filing an amicus brief in the U.S. Supreme Court case Braidwood Management v. Kennedy. The brief supports the constitutionality of the provision (Section 2713) of the Affordable Care Act (ACA) that requires most private insurers cover preventive services recommended by the United States Preventive Services Task Force (USPSTF) without cost-sharing by patients.  

Background

On March 30, 2023, Judge Reed C. O’Connor of the U.S. District Court for the Northern District of Texas ruled in favor of Braidwood Management Inc., blocking enforcement of Section 2713. The judge deemed the USPSTF recommendations unconstitutional because its members are not presidentially appointed or Senate-confirmed. Additionally, the decision concluded that requiring employers to cover Pre-Exposure Prophylaxis (PrEP) medications for HIV prevention without cost-sharing violates the Religious Freedom Restoration Act.  

The case was appealed to the Fifth Circuit which issued a mixed ruling on the case, holding the requirement to provide no-cost preventive services recommended by the USPSTF is unconstitutional.  However, the Fifth Circuit limited the scope of the relief to the plaintiffs only, keeping the preventive services requirement in effect.

Looking Ahead

The future of preventive care access under the ACA now rests with the Supreme Court which is scheduled to hear oral arguments on April 21. In a brief filed with the Supreme Court on February 18, the Trump Administration signaled its intention to defend the ACA preventive services mandate.  

If the Supreme Court were to uphold the Fifth Circuit’s ruling, health plans and issuers would no longer be required to cover without cost sharing preventive services with an ‘A’ or ‘B’ recommendation made by the USPSTF on or after the March 23, 2010 — the date of the ACA’s enactment.  It is possible preventive services that received an ‘A’ or ‘B’ recommendation prior to March 23, 2010 but were subsequently updated, such as applying the recommendation to different populations, could be implicated as well.  

In Defense of Preventive Services

The amicus brief supported by ACOI provides extensive scientific data demonstrating that preventive services save lives and are cost-effective. It is estimated 152 million Americans with private insurance have access to preventive services with zero cost sharing. As the brief highlights, if the Fifth Circuit decision is upheld, many Americans would suddenly be faced with formidable financial barriers to life-saving preventive services, and more than a decade’s worth of progress in improving health outcomes would be reversed.  

ACOI is closely monitoring developments in the case and will provide updates as they become available.  

All documents in this case filed with the Supreme Court are available to the public.