Supreme Court preserves key part of the ACA

The Supreme Court ruled Friday that an Affordable Care Act provision requiring insurers to cover certain preventive care is constitutional.

In a 6-3 decision authored by Justice Brett Kavanaugh, the justices upheld the authority of the U.S. Preventive Services Task Force and protected access to preventive care for an estimated 150 million Americans.

At issue in the case of Braidwood Management v. Kennedy was a provision in the ACA that requires private health insurers and companies to cover preventive services and drugs such as HIV preventive drugs, known as PrEP. The provision also requires coverage of cancer screenings, vaccines, sexually transmitted disease screenings, gestational health screenings and birth control.

Braidwood contended that this requirement violated the company’s religious freedom and beliefs.

Preventive Task Force

Another issue in the Braidwood case is whether the Preventive Task Force that decides which services must be covered under the ACA is constitutionally sound.

The justices found the secretary of the Department of Health and Human Services has the authority to appoint and fire members of the Preventive Services Task Force; their work is “directed and supervised” by the HHS Secretary so they do not need to be confirmed by the Senate. The court reinforced the ability of the HHS secretary to exert control over the panel’s recommendations.

“Task Force members issue preventive-services recommendations of critical importance to patients, doctors, insurers, employers, health care organizations, and the American people more broadly. In doing so, however, the Task Force members remain subject to the Secretary of HHS’s supervision and direction, and the Secretary remains subject to the President’s supervision and direction,” Kavanaugh wrote for the majority. “The structure of the Task Force and the manner of appointing its officers preserve the chain of political accountability that was central to the Framers’ design of the Appointments Clause.”

The task force is composed of medical experts who serve four-year terms on a volunteer basis. They are appointed by the HHS secretary and are supposed to be shielded from political influence.

The plaintiffs argued the USPSTF mandates are unconstitutional because the task force’s members are “inferior officers” who aren’t appointed by the president or confirmed by the Senate.

The ACA specifies four main categories of preventive care for all adults as well as for women and children in particular:

1. Services with an A or B rating in the current recommendations of the U.S. Preventive Services Task Force.
2. Immunizations recommended by the Advisory Committee on Immunization Practices.
3. Preventive care and screenings for infants, children, and adolescents in comprehensive guidelines supported by the Health Resources and Services Administration.
4. Preventive care and screenings for women’s health specified in the HRSA guidelines.

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