United States Supreme Court Upholds HHS Authority Over ACA Preventive Service Requirements 

The United States Supreme Court has issued its ruling in a case challenging the Affordable Care Act’s (ACA) preventive services coverage requirements. The plaintiff argued that members of the United States Preventive Services Taskforce (USPSTF) were unconstitutionally appointed because they were not nominated by the President and confirmed by the Senate. However, the Court disagreed, holding that USPSTF members are “inferior officers” and that Congress may lawfully vest their appointment authority in the Secretary of Health and Human Services (HHS).  

The case, Braidwood Mgmt. Inc. v. Becerra (Braidwood), originated in a Texas district court. There, a federal judge ruled that non-grandfathered group health plans and insurers were no longer required to cover certain preventive services without cost-sharing. These services are based on recommendations from the USPSTF, a panel of experts in primary care and prevention whose guidance is often adopted by HHS.  

Had the plaintiffs prevailed, all USPSTF recommendations issued since 2010 could have been invalidated. However, because USPSTF members are supervised by the HHS Secretary, who is accountable to the President, the Supreme Court reversed the Fifth Circuit Court of Appeals’ decision. 

Background

 
Section 2713 of the Public Health Service Act (PHS) requires that non-grandfathered group health plans and health insurance issuers that offer non-grandfathered group or individual health insurance coverage provide benefits for and prohibit cost-sharing requirements to: 

• Evidence-based items or services that have a rating of “A” or “B” as currently recommended by the USPSTF, except 2009 regulations regarding breast cancer screening, mammography, and prevention 
• Immunizations for routine use in children, adolescents and adults that have a recommendation from the Advisory Committee on Immunization Practices of the CDC 
• Evidence-informed care for infants, children and adolescents found in the comprehensive guidelines supported by the Health Resources and Services Administration (HRSA) 
• Preventive care and screening for women in a comprehensive guideline supported by the HRSA

 

Braidwood Challenge

 
The plaintiffs in Braidwood argued that the Appointments Clause, Vesting Clause, and the nondelegation doctrine of the US Constitution prohibit the USPSTF and similar bodies from issuing binding recommendations. The district court agreed and vacated all coverage requirements tied to USPSTF “A” or “B” ratings. On appeal, the Fifth Circuit Court of Appeals lifted the nationwide injunction but ruled that the mandates could not be enforced against the plaintiffs.  

Impact on Employers 

The Supreme Court’s decision maintains the status quo for ACA preventive care requirements. Non-grandfathered health plans must continue to cover all required preventive services without cost-sharing.  

However, this is unlikely to be the final challenge to the ACA. In addition to the Appointment Clause issue, the Braidwood plaintiffs also argued that the Religious Freedom Restoration Act (RFRA) exempts them from covering certain HIV -prevention medications. They prevailed on that claim at the appellate level, and neither party appealed that portion of the ruling to the Supreme Court. As a result, more employers with religious objections may seek similar exemptions.  

As always, OneDigital will continue to monitor all relevant health and welfare plan litigation. Continue to regularly monitor our Compliance Confidence blog for the latest updates.