Since
2010,
when
the
Affordable
Care
Act
was
enacted,
most
private
insurance
plans
have
been
required
to
cover
preventive
care
services
recommended
by
the
U.S.
Preventive
Services
Task
Force
without
making
consumers
pay
a
share
of
the
cost.
This
includes
cancer
screenings,
pregnancy
care
and
testing
for
sexually
transmitted
diseases.
It’s
estimated
that
in
2020
alone,
nearly
152
million
people
have
benefited
from
this
law.
But
a
pending
Supreme
Court
case
puts
this
in
jeopardy.
This
month,
the
Supreme
Court
will
hear
oral
arguments
on
Braidwood
Management
v.
Becerra.
In
this
case,
several
Texas
residents
and
two
Christian-affiliated
businesses
sued
the
government,
arguing
that
the
way
the
task
force
was
appointed
violates
the
constitution.
They
also
argued
that
the
requirement
to
cover
medications
that
prevent
HIV
infection
goes
against
their
religious
beliefs.
In
2022,
Judge
Reed
O’Connor,
of
the
Federal
District
Court
for
the
Northern
District
of
Texas
sided
with
the
plaintiffs,
stating
that
the
task
force
had
not
been
properly
appointed
by
Congress
and
therefore,
doesn’t
have
constitutional
authority
to
require
insurers
to
cover
certain
services.
The
U.S.
Court
of
Appeals
for
the
Fifth
Circuit
affirmed
the
ruling
June
2024.
If
the
Supreme
Court
upholds
the
5th
U.S.
Circuit
Court
of
Appeals
ruling,
the
government’s
ability
to
require
insurers
and
employers
to
cover
preventive
services
without
cost-sharing
could
be
severely
limited.
“We
know
from
years
of
research
that
people
who
face
cost
sharing,
particularly
if
they
are
low
income,
are
much
less
likely
to
get
needed
healthcare,”
said
Sara
R.
Collins,
Ph.D.,
senior
scholar
and
vice
president
for
health
care
coverage
and
access
at
the
Commonwealth
Fund,
a
private
foundation
focused
on
healthcare.
“Preventive
services
is
one
such
service
that
we
know
it’s
important
for
people
to
get.
Not
only
for
themselves,
but
also
for
the
broader
community,
and
just
for
cost
savings
down
the
road.”
The
case
The
plaintiffs’
argument
is
really
two-fold,
according
to
Daniel
Frier,
founding
partner
of
Frier
Levitt.
First,
they’re
arguing
that
the
preventive
services
provision
violates
the
appointments
clause,
which
requires
that
officers
of
the
U.S.
only
be
appointed
by
the
president
with
advice
and
consent
of
the
Senate.
Members
of
USPSTF
were
not
nominated
by
the
president
and
approved
by
the
Senate.
Their
other
argument
is
that
covering
benefits
like
preexposure
prophylaxis
(PrEP),
which
is
used
to
prevent
HIV,
goes
against
their
religious
beliefs,
which
violates
the
Religious
Freedom
Restoration
Act.
There
are
a
few
possibilities
for
how
the
case
could
play
out.
The
plaintiffs
could
win
on
the
Religious
Freedom
Restoration
Act,
but
lose
on
the
appointments
clause,
Frier
said.
This
would
mean
that
the
preventive
care
mandate
would
remain
valid,
but
religious
employers
would
get
an
exemption
on
services
like
PrEP.
Or
the
plaintiffs
could
win
on
the
appointments
clause
and
lose
on
the
Religious
Freedom
Restoration
Act,
which
would
essentially
strike
down
the
entire
preventive
service
mandate,
he
said.
The
plaintiffs
could
also
win
on
both
arguments,
which
would
be
sweeping
in
ending
the
preventive
care
mandate.
Alternatively,
the
government
could
win
both
arguments
and
the
mandate
would
remain
in
place,
regardless
of
religious
beliefs.
Frier,
however,
believes
that
it
could
be
likely
that
the
Supreme
Court
sides
with
the
plaintiffs
on
the
Religious
Freedom
Restoration
Act,
particularly
because
the
Supreme
Court
has
been
sympathetic
to
religious
beliefs
in
the
past.
“They
might
say
that
the
task
force
is
constitutional,
but
its
decision
related
to
the
types
of
issues
that
religious
organizations
might
find
inappropriate
is
not
enforceable,”
he
said.
“That
could
open
up
a
huge
can
of
worms
for
healthcare
decisions.
You
could
have
religious
organizations
that
don’t
believe
in
transfusions.
You
have
religious
organizations
that
don’t
believe
in
treatment
of
certain
types
of
illnesses
or
pregnancy
prevention
or
pregnancy
terminations.”
What’s
at
stake
If
the
Supreme
Court
upholds
the
lower
court’s
decision
that
the
task
force
is
unconstitutional,
then
the
requirement
for
private
insurers
to
cover
services
recommended
by
the
U.S.
Preventive
Services
Task
Force
after
2010
(when
the
ACA
was
enacted)
would
essentially
go
away,
according
to
Collins
of
the
Commonwealth
Fund.
This
includes
screenings
for
colorectal
cancer,
medications
to
reduce
breast
cancer,
statins
to
prevent
cardiovascular
disease,
screening
for
Hepatitis
B
infection
and
more.
“These
are
not
static
recommendations,
and
the
task
force
meets
and
updates
recommendations
based
on
emerging
evidence
about
illness
[and]
disease,
and
as
new
technologies
emerge.
…
So
it’s
very
important
that
the
task
force
keeps
meeting,
that
they
keep
providing
the
recommendations,”
Collins
stated.
An
executive
at
a
women’s
health
company
is
hopeful
that
the
preventive
care
provision
remains
intact.
“Preventive
care
saves
lives.
This
is
not
controversial.
We
know
that
when
people
have
preventive
care,
we
prevent
catastrophic
events.
We
know
that
when
preventive
care
is
covered
and
people
do
not
have
an
out
of
pocket
cost
associated
with
it,
they
engage
in
preventive
care.
The
consequence
of
this
case,
resulting
in
the
overturn
of
the
preventive
care
clause,
will
have
catastrophic
consequences
for
decades,”
said
Jessica
Horwitz,
chief
clinical
officer
of
Tia,
in
an
interview.
Another
healthcare
executive
noted
that
getting
rid
of
the
preventive
services
requirement
could
lead
to
more
costs
down
the
road.
“There
is
a
growing
body
of
research
that
shows
that
putting
more
of
the
cost-sharing
burden
on
patients
actually
decreases
the
use
of
high-value
care.
If
insurers
do
not
cover
these
preventive
services,
we
will
certainly
see
downstream
impacts
on
both
total
cost
of
care
and
health
outcomes
when
care
is
inevitably
delayed
due
to
out-of-pocket
costs,”
said
Ami
Parekh,
chief
health
officer
at
Included
Health.
The
company
serves
employers
and
health
plans
and
offers
primary
and
behavioral
health
support.
In
other
words,
insurers
or
employers
will
end
up
paying
more
for
acute
incidents
that
may
have
been
prevented
with
cheaper
screening.
It’s
possible
that
many
health
plans
and
employers
will
continue
to
cover
these
services
without
cost
sharing
even
if
the
Court
rules
in
favor
of
the
plaintiffs
because
it’s
in
their
best
interest,
according
to
Frier.
“Providing
preventive
care
is
a
form
of
value-based
care,”
Frier
said.
“It
ultimately
reduces
the
overall
cost
of
care
over
time.
So
employers,
for
example,
are
highly
incentivized
to
provide
preventive
care
because
…
it
prevents
absenteeism
at
work.
It
improves
performance
at
work.
Employers
don’t
want
their
employees
to
get
sick.”
While
financially
it
might
be
wiser
for
insurers
to
cover
screenings
without
requiring
cost
sharing,
without
the
preventive
care
provision
in
place,
it
would
certainly
not
be
at
the
level
it
is
now,
he
added.
The
Supreme
Court
will
hear
oral
arguments
on
the
case
April
21.
Photo:
Valerii
Evlakhov,
Getty
Images