This week, the U.S. Supreme Court heard oral arguments in Kennedy v. Braidwood Management, a pivotal case challenging the Affordable Care Act’s (ACA) mandate that insurers cover preventive health services without cost-sharing.
As part of the ACA, insurers must provide cost-free coverage for preventative services that have been recommended by the U.S. Preventive Services Task Force (USPSTF), a longstanding body that makes expert, evidence-based recommendations to clinicians. The Task Force makes preventative care recommendations, such as timing for cancer screenings, certain vaccines, behavioral counseling, depression screenings, and well-baby visits, among many others. These services are covered by health plans in the ACA marketplace at no cost to the patient. Patients who have care under the Medicaid expansion would also be affected, as they must also cover Essential Health Benefits, which are defined by CMS as the benefits required by the marketplace plans.
The plaintiffs contend that the USPSTF, lacks constitutional authority because its members are not appointed by the President and confirmed by the Senate, as required for “principal officers” under the Appointments Clause. They also argue that mandating coverage for certain services, like HIV prevention drugs, infringes upon their religious freedoms.
Key Takeaways for Hospitals and Health Systems:
- Potential Disruption to Preventive Care Access: If the Court rules against the USPSTF’s authority, insurers may no longer be required to cover preventive services without cost-sharing. This could lead to reduced patient access to essential services like cancer screenings, immunizations, and HIV prevention, particularly affecting low-income and vulnerable populations. Hospitals may see an increase in advanced disease cases due to delayed or foregone preventive care.
- Financial Implications: The elimination of mandatory no-cost preventive services could shift costs to patients, potentially decreasing utilization rates. Hospitals might experience higher uncompensated care costs and increased financial strain from treating more advanced illnesses that could have been prevented or mitigated with early intervention.
- Operational Challenges: Health systems may need to adjust care delivery models, patient education, and billing practices to accommodate changes in coverage requirements. This could involve revising preventive care protocols and navigating varying insurance plan coverages, adding complexity to administrative operations.
- Policy and Advocacy Considerations: A ruling that diminishes the USPSTF’s role may set a precedent affecting other health-related advisory bodies and their influence on coverage mandates. Hospitals and health systems may need to engage more actively in policy advocacy to support evidence-based preventive care standards and ensure continued access for patients.
While the Supreme Court’s decision is pending, hospitals and health systems should monitor developments closely and prepare for potential changes in preventive care coverage that could impact patient access and organizational operations.
