The U.S. Supreme Court is expected to issue a ruling soon in a pivotal legal dispute regarding the constitutionality of a key component of the Affordable Care Act’s (ACA) preventive care mandate. The Court’s decision in this case, Kennedy v. Braidwood Management Inc., will impact the requirement for health plans and health insurance issuers to cover, without cost sharing, a wide range of preventive care services, including screenings for colorectal, lung and cervical cancers; medications for chronic conditions, such as cardiovascular disease; screening for HPV; depression and anxiety screenings; and hepatitis B and C virus screenings.
In June 2024, the 5th U.S. Circuit Court of Appeals ruled that a key component of the ACA’s preventive care mandate is unconstitutional. However, the 5th Circuit limited its ruling to the plaintiffs in the case, a small group of individuals and businesses from Texas. This means that health plans and issuers have been required to continue to provide first-dollar coverage for the full range of recommended preventive health services. However, the Supreme Court’s decision could lead to a nationwide shift in coverage if the Court rules in the plaintiffs’ favor. A ruling is expected by mid-2025.
ACA’s Preventive Care Mandate
The ACA requires non-grandfathered health plans and issuers to cover a set of recommended preventive services without imposing cost-sharing requirements, such as deductibles, copayments or coinsurance, when the services are provided by in-network providers. The recommended preventive care services covered by these requirements are:
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Evidence-based items or services with an A or B rating in recommendations of the U.S. Preventive Services Task Force (USPSTF);
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Immunizations for routine use in children, adolescents and adults recommended by the Advisory Committee on Immunization Practices;
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Evidence-informed preventive care and screenings in guidelines supported by the Health Resources and Services Administration (HRSA) for infants, children and adolescents;
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Other evidence-informed preventive care and screenings in HRSA-supported guidelines for women.
Legal Dispute
In March 2023, the U.S. District Court for the Northern District of Texas struck down a key component of the ACA’s preventive care mandate. The District Court ruled that the preventive care coverage requirements based on an A or B rating by the USPSTF on or after March 23, 2010, violate the U.S. Constitution. The court concluded that USPSTF members are “principal” officers under the Appointments Clause and must be nominated by the president and confirmed by the Senate, which was not the case.
The District Court also issued a nationwide injunction prohibiting the government from enforcing the affected mandates. The Biden administration appealed, and the 5th Circuit put the lower court ruling on hold. The 5th Circuit agreed that USPSTF members were not properly appointed but limited relief to the plaintiffs only.
On Jan. 10, 2025, the Supreme Court agreed to hear the challenge and heard oral arguments on April 21, 2025. A decision is expected in June or July 2025.
Possible Impact
If the Supreme Court rules in favor of the federal government, the ACA’s preventive care mandate will remain intact, and plans must continue full coverage of preventive services without cost sharing.
However, if the Court rules against the mandate, employers should work with their health plans or TPAs to determine the impact. While changes may not be immediate, any midyear plan modifications could require 60-day advance notice. State-level laws for insured plans would remain in effect. Additionally, some employers may voluntarily maintain coverage to help control long-term costs related to preventable conditions.
This Legal Update is not intended to be exhaustive nor should any discussion or opinions be construed as legal advice. Readers should contact legal counsel for legal advice. © 2025 Zywave, Inc. All rights reserved.