By Sunita Sohrabji

The Supreme Court heard oral arguments April 21 in a case that could upend free preventive screenings and services for people insured via the Affordable Care Act.

The ACA covers a raft of free preventive services recommended by the US Preventive Services Task Force. Such services include free screenings for various cancers, blood pressure, cholesterol, diabetes, depression, dementia, reproductive care, flu shots and more.

If the justices rule in favor of the plaintiffs, these services and screenings would be subject to co-pays and deductibles.

”Prior to the ACA, the cost of basic screenings disincentivized people from getting them,” said Dr. Georges Benjamin, executive director of the American Public Health Association. “It is important to maintain these free services. If we don’t, we’re going to see more heart disease, more cancers, more preventable deaths,” said Benjamin at an April 17 press conference.

Disproportionate Impact to Women

”Women are more cost sensitive, and are more likely to deny care for themselves,” said Dorianne Mason, director of health equity at the National Women’s Law Center. “Women will suffer disproportionately if there is a cost for screenings. Disparities will deepen if there is a cost associated with screenings,” she said.

The ACA currently covers free contraceptives, Mason noted.

Kathy Hempstead, senior policy officer at the Robert Wood Johnson Foundation, noted that fewer women got mammographies when they had to pay for the screening. “The use of preventive care has increased dramatically since the ACA,” she said. For example, statins are provided free to folks at increased risk for heart disease, noted Hempstead. She added that colorectal screenings for young adults and screenings for Type 2 diabetes have also increased.

”The US spends almost $5 trillion a year on health care, but we’re at the bottom of the wellness list for industrialized nations,” said Benjamin. “We believe strongly in preventive health screenings for improving the overall quality of life.”

HIV/AIDS Prevention

The ACA also mandates health care providers to offer HIV/AIDS prevention screenings and distribution of pre-exposure prophylaxis. The plaintiffs, Braidwood Management, argue that covering PrEP violates their religious freedom and creates an undue financial burden. They also contend that the USPSTF violates the Constitution’s Appointment Clause, since its members are not appointed by the President nor confirmed by the Senate. Thus, the task force cannot make recommendations for preventive services, contends Braidwood.

The case puts the Trump Administration in the unusual position of having to defend the Affordable Care Act. President Donald Trump had repeatedly attempted to dismantle the ACA during his 1st term. Filed in 2022, the lawsuit initially named former Health and Human Services Secretary Xavier Becerra, but now names HHS Secretary Robert F. Kennedy Jr.

HHS Oversight

In court April 21, justices debated whether task force members are “principle officers” who must be appointed by the President. Attorney Hashim Mooppan, arguing for the Trump Administration, told the court that the HHS secretary can remove task force members at will. He can also review their recommendations and prevent them from taking effect.

“Given these collective powers of supervision, the task force cannot issue final recommendations that bind the public unless the secretary permits them to do so,” said Mooppan, as reported by Reuters.

The SCOTUS Blog reported that the majority of justices — including Amy Coney Barrett and Brett Kavanaugh — appear to support leaving the task force in place.