Health groups praise Supreme Court ruling that affirms authority of USPSTF

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Health advocacy organizations are praising a U.S. Supreme Court ruling that protects insurance coverage for preventive tests that primary care physicians order for patients.

On June 27, the High Court issued its ruling in the case known as Kennedy vs. Braidwood Management Inc.

The case involved a challenge of the legal authority of the U.S. Preventive Services Task Force (USPSTF). The Affordable Care Act granted the task force the authority to recommend services that insurance companies must cover to make available free for patients. Businesses contesting that authority argued about appointment power of the secretary of Health and Human Services (HHS) to name 16 members of the USPSTF. The panel remains independent, but works with the federal Agency for Healthcare Research and Quality under HHS.

The case so far

At least two businesses challenged the USPSTF’s authority to issue “numerous decrees that force insurers to cover items and services without cost-sharing” to patients. That includes the pre-exposure prophylaxis (PrEP) drugs, such as Truvada and Descovy, used to fight HIV infection, according to a court brief.

But those medicines aren’t the only drugs or screenings involved. Preventive services include cancer screenings, tobacco cessation, contraception and immunizations involving more than 150 million people a year, according to an estimate published by the O’Neill Institute’s Health Care Litigation Tracker of Georgetown University. NBC News also cited the 150 million people and predicted a ruling “could have sweeping consequences for patient access to preventive health care” across the country.

Earlier court rulings sided with the businesses challenging the USPSTF authority.

Justices say …

The court case hinged on appropriateness of the authority of the USPSTF to issue the recommendations about preventive services. The Supreme Court ruling dealt more with appointment power of the HHS secretary, than with any single health test, screening method or diagnosis.

The USPSTF members are considered government “inferior officers” subject to the supervision and direction of the nation’s secretary for HHS, who in turn remains under the supervision of the president, said thenJune 27 ruling authored by Justice Brett M. Kavanaugh, writing also for Chief Justice John G. Roberts, Jr.,and Justices Sonia Sotomayor, Elena Kagan, Amy Coney Barrett and Ketanji Brown Jackson.

That appointment power and authority preserves the chain of political accountability that the Framers of the Constitution intended, they said.

Dissenting view

Justices Clarence Thomas, Samuel A. Alito, Jr., and Neil M. Gorsuch dissented. They argued the Constitution is clear that 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,” Thomas’ dissent said. “The Framers established this rule to ensure that the president is accountable for the selection of officers in the Executive Branch. And, it is the law, whether we agree with it or not.”

Good for the heart, lungs and more

Health groups and AHIP, the trade organization for America’s health insurance plans, all praised the ruling.

AcademyHealth, American Heart Association, American Lung Association, Campaign for Tobacco-Free Kids, GO2 for Lung Cancer, Public Citizen and Truth Initiative published a joint statement on the ruling.

“On behalf of our organizations and the people we serve, we applaud the U.S. Supreme Court for protecting cost-free coverage of preventive services for more than 150 million people in the United States,” the organizations said.

“Access to preventive services without cost-sharing saves lives and improves the health of our nation,” the joint statement said. “The lower court’s ruling would have jeopardized access to preventive services and the progress we have made in reducing the burden of chronic disease. Access to preventive care – including screenings for cancer, medications for cardiovascular disease and helping people quit smoking – is essential to lowering health care costs for patients and making our nation healthier. By detecting conditions like cancer earlier, we can dramatically improve the chances of survival: For example, the five-year survival rate for lung cancer patients is 64% when the cancer is caught before a tumor spreads, compared to just 9% if the cancer is caught at a late stage.

“Thankfully, the Supreme Court ruled to protect this vital health care coverage so insurers will continue to provide cost-free access to this lifesaving preventive care. Now, we urge U.S. Health and Human Services Secretary Robert F. Kennedy to ensure lifesaving preventive care is preserved by supporting the USPSTF and its evidence-based recommendations.”

Avoid political manipulation

Mona Shah, senior director of policy and strategy for health care access advocacy group Community Catalyst, noted the potential for “political manipulation” across medicine.

“While the Court upheld the existing coverage mandate for no-cost preventive care, the integrity of that protection depends on keeping USPSTF free from political manipulation,” Shah said. “If preventive care recommendations are no longer grounded in science, insurers will have the green light to shift costs back onto patients, forcing people to pay for cost-saving, preventive care that should be universally accessible.

“We know the reality: Even modest co-pays can stop someone from getting a cancer screening or HIV test,” Shah said. “That is not just bad policy, it is a direct path to delayed diagnoses, worse health outcomes, and crushing medical debt, especially in communities that already face deep inequities.

“No-cost preventive care is one of the most popular and effective parts of the Affordable Care Act,” Shah’s statement said. “People count on it to stay healthy. Undermining it through political interference is not just dangerous, it is deeply out of step with what communities want and need.

“Community Catalyst remains committed to protecting access to preventive care that is guided by evidence, not ideology, and ensuring everyone, no matter their income or background, can get the care they need without cost standing in the way,” Shah said.

Insurers agree

“Health plans have long supported affordable access to evidence-based preventive care to help people stay healthy – including coverage for recommended services with no cost sharing,” said the statement from AHIP. “With this ruling, there are no impacts to existing coverage, and we will closely monitor the ongoing legal process.”

How is RFK Jr. involved?

The case originally was named partly for Xavier Becerra, HHS secretary under President Joe Biden. Under the new administration of President Donald J. Trump, the case has become known as Robert F. Kennedy Jr., secretary of Health and Human Services, vs. Braidwood Management Inc., et al. While it may seem unexpected that HHS under Trump would defend a legal challenge to the Biden administration, KFF noted a ruling “could give the administration broader latitude to shape the recommendations issued by the entities that were originally established with the goal of providing independent analysis and review.”