Topline
The Supreme Court upheld Friday the legality of the task force that decides which preventive health services should be covered under the Affordable Care Act, avoiding a ruling that could have raised healthcare costs for millions of Americans—though other aspects of the case are still moving forward.
A demonstrator holds up a pro-Affordable Care Act sign outside the U.S. Supreme Court on Nov. 10, … More
Key Facts
The Supreme Court ruled 6-3 in favor of the government in Kennedy v. Braidwood Management, a dispute over the legality of the task force that makes recommendations about what preventive services should be covered under the Affordable Care Act.
The ACA, also known as Obamacare, requires health insurance companies to cover preventive services, and leaves it up to the U.S. Preventive Services Task Force to make recommendations about which specific services should be covered.
As part of a lawsuit seeking to stop HIV medication PrEP from being covered under the ACA, a group of Christian-owned businesses and individuals challenged whether any recommendations by the U.S. Preventive Services Task Force were lawful, claiming the task force’s members should be nominated by the president and confirmed by the Senate, rather than appointed by the health secretary.
Justices ruled the task force’s members were lawfully appointed and do not have to be appointed by the president, and the Health Secretary has the power to review the recommendations they make.
A ruling in favor of the businesses would have destabilized millions of Americans’ healthcare by invalidating the task force’s previous recommendations about covered services, meaning many preventive services may have no longer been covered by insurance.
The ruling does not necessarily leave Americans’ benefits settled, however: other aspects of the case are still moving forward in lower courts, KFF notes, and the court ruled the Health Secretary has broad power over the task force’s recommendations, meaning Secretary Robert F. Kennedy Jr. could still try to stop some services from being covered.
What We Don’t Know
If Kennedy could still take steps to block some preventative services from being covered under the ACA going forward, as the Supreme Court greenlit the health secretary’s broad authority over the task force in its ruling Friday. “Through the power to remove and replace Task Force members at will, the [Health] Secretary can exert significant control over the Task Force—including by blocking recommendations he does not agree with,” Justice Brett Kavanaugh wrote in his majority opinion for the court. Politico notes the ruling could also empower Kennedy to exert broad power over other government task forces—such as the one covering vaccines that he’s already made controversial changes to—using the high court’s ruling as justification for his influence over them.
Chief Critic
Justice Clarence Thomas dissented from the court’s opinion, arguing the majority “distorts Congress’s design for the Task Force, changing it from an independent body that reports directly to the President to one subject to the control of the Secretary of HHS.” “Under our Constitution, appointment by the President with Senate confirmation is the rule. Appointment by a department head is an exception that Congress must consciously choose to adopt … it is the law, whether we agree with it or not,” Thomas wrote in his dissent, which was joined by Justices Samuel Alito and Neil Gorsuch.
What Preventive Services Could Have Been Affected?
While Braidwood Management’s initial lawsuit challenged PrEP specifically, taking issue with its predominant use among gay men, the U.S. Preventive Services Task Force has made a number of recommendations for preventive services that should be covered, which the Supreme Court case could have put at risk. Those services include a number of different kinds of cancer screenings—including for lung cancer, colorectal cancer, breast cancer and cervical cancer—as well as testing for conditions such as diabetes, hypertension, hepatitis B and C, sexually transmitted diseases, osteoporosis and mental health conditions like anxiety and depression. The panel recommended that statins be covered to prevent cardiovascular disease, as well as folic acid and aspirin for pregnant people and preventive medications for people at higher risk of breast cancer. The task force’s recommendations also allow coverage for counseling and other healthcare interventions for things like weight loss, smoking cessation and lowering senior citizens’ fall risk.
Surprising Fact
Though the Biden administration was the one to initially ask the Supreme Court to take up the preventive care dispute, the Trump administration took over the case after Inauguration Day and defended the task force’s legality in court. That pitted the Trump administration against President Donald Trump’s own former lawyer, Jonathan Mitchell, who argued against the task force at the Supreme Court. Mitchell—a prominent conservative lawyer known for his work opposing abortion—previously successfully represented Trump in the legal dispute over whether the now-president could be disqualified from Colorado’s ballot under the 14th Amendment. The case also put the Trump administration against America First Legal Foundation, the right-wing legal group that backed the challengers in the case. That organization was founded by Trump’s White House advisor Stephen Miller.
Key Background
The Braidwood case came to the Supreme Court after multiple lower courts previously ruled against the government and declared the task force unlawful. Plaintiffs initially brought the case in 2020, taking issue with the requirement that PrEP be covered under the ACA and the task force’s legality more broadly. A Texas-based district judge agreed, invalidating all of the panel’s recommendations since the ACA was first established in 2010. The case then went to the conservative-leaning 5th Circuit Court of Appeals, where judges similarly ruled against the task force not being presidentially appointed. The appeals court declined to totally invalidate the panel’s recommendations, however, only blocking the plaintiffs who brought the case from having to cover those services. The lawsuit is the latest dispute over the ACA to make it to the high court, as Republicans’ longstanding opposition to the healthcare policy has sparked a number of court challenges. Justices ruled in 2012 to uphold the constitutionality of the law and its mandate for Americans to purchase health insurance, though it limited its expansion of Medicaid. The court then upheld the law again in 2015, ruling in favor of its federal tax credits, before once again coming out in favor of the law in 2021, striking down another challenge arguing the law’s mandate for buying insurance was unconstitutional.
This story is breaking and will be updated.
Further Reading
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