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Supreme Court Upholds Key Obamacare Measure On Preventive Care
The U.S. Supreme Court Chip Somodevilla/Getty Images hide caption
toggle caption Chip Somodevilla/Getty ImagesThe Supreme Court on Friday upheld a key provision of the Affordable Care Act, ensuring, at least for now, that some 150 million people will continue getting many free, preventive services under the act.
The vote was 6-3, with Chief Justice John Roberts, and Justices Amy Coney Barrett and Brett Kavanaugh joining the court's three liberal justices in the majority.
Siding with the government on Friday, the court upheld the Affordable Care Act, allowing the U.S. Preventive Services Task Force to continue determining which services will be available free of cost to Americans covered by the Affordable Care Act.
Sponsor MessageAt issue in the case was a lawsuit that sought to undo the preventive care provision by challenging the appointment process for members of a 16-person task force that determines which preventive services are to be provided for free under insurance policies. Two lower courts found that the appointments were unconstitutional, but on Friday, the Supreme Court disagreed.
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More Supreme Court decisions today:
Writing for the court majority, Justice Kavanaugh said the Department of Health and Human Services has the power to appoint members of the task force.
Law Supreme Court limits nationwide injunctions in birthright citizenship order"Task Force members are supervised and directed by the Secretary, who in turn answers to the President, preserving the chain of command in Article II," Kavanaugh wrote.
The ACA's preventive treatments have benefited millions of people since the health care law went into effect 11 years ago — a sufficiently long time for most people to take the free coverage for granted. Activists argued that if the court ruled for the groups challenging the law, the benefits could disappear.
Friday's case arose when the preventive care task force classified pre-exposure prophylaxis (PrEP) drugs as essential to preventing HIV. Preventive PrEP coverage under the ACA includes not only HIV testing and medication, but also clinic visits and lab testing without added cost-sharing. Without ACA coverage, PrEP care would be astronomically expensive for most Americans.
The suit was brought by individuals and businesses with religious objections to the PrEP mandate—they claimed that providing PrEP coverage encourages "sexual behaviors and drug use" antithetical to their Christian beliefs.
Braidwood Management, the case's named plaintiff, is led by Republican mega donor Steven Hotze who has referred to members of the LGBTQ+ community at different times as "morally degenerate," "satanic," and "termites." Hotze, has challenged the ACA in at least two other federal lawsuits.
The court's decision on preventive care likely will protect other existing preventive services under ACA, including treatment for blood pressure screenings, as well as birth control, breast and lung cancer screenings, immunizations, and more.
Prior to the court's decision on Friday, proponents of the ACA's existing preventive coverage had worried that without it, the financial burden of out-of-pocket expenses for these services would have discouraged people from getting care to prevent or detect disease at an early and treatable stage.
"I cannot think of another health policy that impacts more Americans than the preventive services provision," said Dr. Mark Fendrick, a professor of medicine and public health at the University of Michigan.
Two lower courts in Texas found that the government violated the Appointments Clause of the Constitution because its task force members were appointed not by the president, but by the secretary of Health & Human Services.
Health What does a 2nd Trump term mean for the Affordable Care Act?The Supreme Court, however, disagreed, declaring that the task force was not composed of principal officers who must be appointed by the president and confirmed by the Senate. Rather, the court said, the advisory panel is composed of "inferior officers," who may be appointed by a department head if that power is designated by Congress. Moreover, as the government pointed out in its briefs, the task force members are directly supervised by the HHS secretary, and members can be terminated at will.
Supreme Court Upholds Obamacare Provision For No-cost Preventive Services
The U.S. Supreme Court ruled to protect a key provision of the Affordable Care Act that requires health insurers to cover preventive care such as cancer screenings at no cost to patients.
The 6-3 ruling stemmed from a lawsuit filed by a group of Christian-owned businesses alleging the U.S. Preventive Services Task Force, which chooses what services will be covered, is composed of members who were not validly appointed. Its 16 members are appointed by the U.S. Secretary of Health and Human Services without Senate confirmation.
The plaintiffs said the process is unconstitutional because a volunteer board of medical experts tasked with recommending which services are covered is not Senate-approved.
President Donald Trump's administration defended the mandate before the court, though the Republican president has been a critic of his Democratic predecessor's law. The Justice Department said board members don't need Senate approval because they can be removed by the health and human services secretary.
Medications and services that could have been affected include statins to lower cholesterol, lung cancer screenings, HIV-prevention drugs and medication to lower the chance of breast cancer for women.
The case came before the Supreme Court after an appeals court struck down some preventive care coverage requirements. The U.S. 5th Circuit Court of Appeals sided with the Christian employers and Texas residents who argued they can't be forced to provide full insurance coverage for things like medication to prevent HIV and some cancer screenings.
Well-known conservative attorney Jonathan Mitchell, who represented Trump before the high court in a dispute about whether he could appear on the 2024 ballot, argued the case.
The appeals court found that coverage requirements were unconstitutional because they came from a body — the United States Preventive Services Task Force — whose members were not nominated by the president and confirmed by the Senate.
A 2023 analysis prepared by the nonprofit KFF found that ruling would still allow full-coverage requirements for some services, including mammography and cervical cancer screening.
Supreme Court Rules 6-3 For Affordable Care Act 'free' Preventive Care Selection Panel
"The task force members are inferior officers, and Congress may invest the power to appoint them in the secretary of HHS," Justice Brett Kavanaugh writes in an opinion for the Supreme Court majority. "Congress has done so, and the secretary has appointed the task force members pursuant to that grant of authority."
Chief Justice John Roberts, Sonia Sotomayor, Elena Kagan, Amy Coney Barrett and Ketanji Brown Jackson also sided with the majority.
What it means: Any benefits that the U.S. Preventive Services Task Force recommended can stay in the basic ACA preventive services package, and the task force can continue to help HHS shape the package.
In the long run, the ruling could affect other federal court cases involving questions about any "inferior officers" — the employees picked by Senate-confirmed government officials — who make recommendations or decisions while serving on federal advisory panels or running federal administrative review systems.
The Affordable Care Act preventive services package: The Affordable Care Act of 2010 requires all non-grandfathered providers of major medical coverage, including fully insured group health plans and employers' self-insured plans, to pay for the products and services in the preventive services package without making the patients pay deductibles, co-payments or coinsurance amounts.
One panel helps HHS pick the vaccines that go into the preventive services package, another panel helps HHS pick items related to women's health and children's health, and the U.S. Preventive Services Task Force helps pick the other items, such as requirements for access to diabetes screenings and cancer screenings.
The appointments clause: The Constitution requires the officers of the U.S. Government to be elected to office or confirmed by the Senate.
The court tends to refer to "superior officers," who are confirmed by the Senate, and to inferior officers, who might be confirmed by the Senate but who might simply be hired by the superior officers.
The Braidwood case: Braidwood Management is a company in Texas that officially employs the people who work for Dr. Steven Hotze.
Braidwood challenged the ACA preventive services coverage requirements in court in 2020.
By the time the case reached the Supreme Court, the case hinged on one question: whether the framework Congress tried to create to make the recommendations of the U.S. Preventive Services Services Task Force independent violated the Constitution.
Braidwood argued that any panel members making independent advice should be confirmed by the Senate.
Kennedy argued that the current structure is constitutional because he has control over the task force members and can fire them at will.
One possibility is that the Supreme Court could have sided with Kennedy in a way that would have hurt the ability of Congress to create useful advisory panels, by giving the president or cabinet secretaries the ability to tell advisory panel members what to say.
Kavanaugh writes in the opinion for the majority that the inferior officers on an advisory panel can express their own views without their ability to express their views violating the appointments clause.
Although the U.S. Preventive Services Task Force members can make final recommendations without facing reviews or appeals, the HHS secretary "has authority to review the task force's recommendations and can block them from taking effect," Kavanaugh writes. "More fundamentally, this court has not suggested that a principal officer must be able to compel a subordinate to take an affirmative act affecting private parties in order for the subordinate to qualify as an inferior officer."
Kavanaugh notes that the Supreme Court has classified patent judges, Coast Guard judges and members of the Public Company Accounting Oversight Board as inferior officers because they are "removable at will" and their decisions can be reviewed and reversed by superior officers, and that the court has allowed the use of systems that let those types of inferior officers make initial decisions free from the direction of supervisors.
Minority views: Justice Clarence Thomas writes in a dissenting opinion that the Supreme Court should have resolved the appointments clause question and then returned the rest of the case to the 5th Circuit.
The new ruling also conflicts with the appointments clause, and it conflicts with how Congress wanted the U.S. Preventive Services Task Force to work, Thomas writes.
The ruling changes the task force "from an independent body that reports directly to the president to one subject to the control of the secretary of HHS," Thomas writes.
Neil Gorsuch and Samuel Alito joined in Thomas's dissent.
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