The Supreme Court said Jan. 10 it would hear the landmark case that challenges a federal task force's authority to require insurers to cover preventive care services under the ACA.
Braidwood Management, a Texas company, and other individuals originally sued HHS in 2021. The company argued the ACA requirement to cover preexposure prophylaxis (PrEP) for HIV prevention under its employee health plan violated the company's religious freedoms.
In March 2023, U.S. District Judge Reed O'Connor ruled that recommendations made by the U.S. Preventive Services Task Force (USPSTF) after 2010 do not need to be complied with and blocked the federal government from enforcing its recommendations. This ruling applied to all private health insurance plans, not just the plaintiffs'. HHS later struck a deal to preserve the mandate while the case was appealed.
In June 2023, the 5th U.S. Circuit Court of Appeals ruled that Braidwood cannot be compelled to pay for PrEP for its employees but reversed the lower court decision that prevented the federal government from enforcing the broader requirements to cover preventive services. The appeals court agreed with Judge O'Connor's ruling that because members of the USPSTF are not confirmed by the Senate, their authority to mandate coverage is unconstitutional. However, it limited the decision to the plaintiffs, leaving the preventive care mandate in place for the broader public. The court also sent the case back to the trial court to reconsider the constitutionality of other coverage recommendations.
"We think it was error, however, for the district court to have also vacated all agency actions taken to enforce the preventive-care mandates and to universally enjoin the defendants from enforcing them," the judges wrote. The coverage requirements remain in place for now, except for the original eight plaintiffs who sued.
The ACA requires payers to cover more than 100 preventive health services with no copays, benefiting over 100 million people each year. While the case's immediate impact is limited, the outcome could have consequences for preventive care coverage nationwide, particularly if future rulings expand the original decision beyond the plaintiffs' plans.
The Supreme Court is expected to issue a decision this spring.