The Supreme Court of the United States will hear arguments this spring from a case that threatens to rollback insurance coverage on preventative care. The case, Braidwood Mgmt., Inc. v. Becerra, 104 F.4th 930, 938 (5th Cir. 2024), challenges the Affordable Care Act’s preventive service requirement, which mandates insurers cover the cost of an array of preventative services, including tobacco cessation, immunizations, heart disease, diabetes screening, contraception, as well as screening for a wide array of medical issues, including heart diseases, lung disease, diabetes, and more. Which preventative services are covered is based on the recommendations of the United States Preventative Services Task Force (USPSTF). The USPSTF is an independent panel of experts who are appointed for four-year terms by the Director of the Agency for Healthcare Research and Quality. USPSTF sets forth recommendations that must be covered by insurers, with the goal of keeping people healthy by preventing sickness or diagnosing a problem before it progresses into something more serious.
The lead plaintiff, Braidwood, filed the case in the U.S. District Court for the Northern District of Texas on the basis that the ACA provision should be struck down because it violated the Religious Freedom Restoration Act (RFRA) and the Appointments Clause. At the district court, Braidwood argued that the ACA mandate requiring coverage of preventative services is a violation of religious beliefs as it makes Braidwood, and the other plaintiffs, “complicit in facilitating homosexual behavior, drug use, and sexual activity outside of marriage between one man and one woman.” On appeal at the 5th Circuit, only the Appointments Clause was at issue, in which Braidwood argued the appointment of the USPSTF Task Force is unconstitutional because the appointees must be nominated by the President and confirmed by the Senate, not an agency.
In late 2024, the 5th Circuit agreed with Braidwood that the ACA provision violates the Appointments Clause. The Justice Department petitioned the Supreme Court to hear the case. This is not the first time the Supreme Court has heard challenges to the ACA. Notable cases include the 2012 decision in National Federation of Independent Business v. Sebelius, 567 U.S. 519 (2012), which, among other decisions, ruled against financial penalties for states failing to expand Medicaid to indigent populations, as well as Burwell v. Hobby Lobby Stores, Inc., 573 U.S. 682 (2014), which found RFRA protections applies to for-profit corporations denying its female employees certain reproductive health care services.
With the incoming administration, it is unclear what the outcome of this case will be, but this will likely be one of many other challenges the ACA will face over the next four years.
Braidwood Mgmt., Inc. v. Becerra, 104 F.4th 930, 938 (5th Cir. 2024), cert. granted, No. 24-316, 2025 WL 65913 (U.S. Jan. 10, 2025), and cert. denied sub nom. Braidwood MGMT. Inc v. Becerra, No. 24-475, 2025 WL 76462 (U.S. Jan. 13, 2025)
