Today, the U.S. Supreme Court will deliberate on a pivotal case concerning the Affordable Care Act (ACA), specifically its mandate requiring insurance companies to cover a range of preventive care services at no cost to patients. This lawsuit has been initiated by conservative employers in Texas, who are challenging the authority of an expert panel that advises the Department of Health and Human Services (HHS) on which preventive services must be included in insurance coverage.
The Texas employers argue that the task forces responsible for recommending preventive care services are unconstitutional. Their claim is rooted in the assertion that the members of these panels are neither confirmed by the Senate nor appointed by a Senate-confirmed agency head. This argument raises significant questions about the legitimacy of the recommendations that shape health care coverage across the nation.
In a surprising turn of events, former President Donald Trump, a longstanding critic of the ACA, aligned his administration with the defense of the law put forth by the Biden administration. Trump's Justice Department has emphasized that the mandate is indeed constitutional, highlighting the authority of Health Secretary Robert F. Kennedy Jr. to oversee the HHS's preventive care task force. This includes the ability to direct the task force's focus on specific services, manage its volunteer members, and potentially suppress recommendations that do not align with the administration's agenda.
Progressive health advocates are on high alert regarding this case. Many have filed amicus briefs expressing their concerns that the current administration may misuse its authority to undermine essential health care services. Leslie Dach, a former senior counselor at HHS and current leader of the group Protect Our Care, voiced apprehensions about the potential consequences, stating, “We are very, very nervous that they will take a sledgehammer to vaccines, take a sledgehammer to contraception, and a number of other preventive services that the American people benefit from and need.”
While vaccines and contraception are not directly implicated in this particular case, as their coverage is determined by different HHS advisory panels, lower federal courts are currently considering challenges to those panels as well. A ruling from the Supreme Court could set a critical precedent that either preserves or restricts access to these essential health services.
In a related aspect of the case, lower federal courts have sided with the Texas employers' claim that certain ACA requirements, including coverage for the HIV-prevention drug PrEP, infringe upon their religious rights. The plaintiffs argue that covering PrEP contradicts their Christian beliefs by "facilitating and encouraging homosexual behavior, prostitution, sexual promiscuity, and intravenous drug use." While the lower courts allowed these employers to opt out of covering PrEP for their employees during the ongoing litigation, the Biden administration chose not to appeal this portion of the ruling.
Although the religious exemption for PrEP is not part of today's arguments, public health experts are concerned that other employers might leverage these lower court rulings to seek similar exemptions. Advocates for HIV/AIDS awareness fear that if the Supreme Court declares the U.S. Preventive Services Task Force unconstitutional, it would empower insurers to selectively determine which preventive services are available without cost-sharing. Anu Dairkee, a fellow at Harvard University’s Health Law and Policy Clinic, explained, “Given the cost of PrEP and the associated services around it, it could be one of the most vulnerable on the list.”
Over a dozen organizations focused on HIV and AIDS have filed amicus briefs urging the court to uphold coverage for PrEP, citing its effectiveness in reducing HIV transmission rates since its approval in 2012. The groups express concern that a ruling against the preventive services mandate could reverse progress toward ending the HIV epidemic, a goal set by Trump during his administration for 2030. Furthermore, federal data indicates that PrEP usage remains low in low-income communities of color, which are at the highest risk for infection. Experts are apprehensive that this trend will worsen if insurance coverage for the drug is compromised.
With PrEP costing as much as $30,000 annually without insurance, maintaining coverage is crucial for ensuring access to this life-saving medication. Carl Baloney, the CEO-elect of AIDS Watch, emphasized the transformative impact of insurance coverage: “PrEP is expensive, and it requires follow-up labs, so insurance coverage has been transformative for its uptake.” He added that ensuring individuals have the freedom to pursue PrEP, as prescribed by their doctors, is essential for public health and combating the HIV epidemic.
