Latest news with #BraidwoodManagement
Medscape
14 hours ago
- Health
- Medscape
Supreme Court Ruling Preserves Access to Preventive Services
Health advocates welcomed a US Supreme Court decision announced Friday that preserves a federal mandate for insurers to cover, without copays, certain preventive medical tests and treatments. The Supreme Court split 6-3 in the decision announced Friday. While the court ruling was seen largely as a win for medical and consumer groups, some voiced concerns about its impact on the Health and Human Services (HHS) Secretary's power over an influential panel, the US Preventive Services Task Force (USPSTF). Anthony Wright, executive director of the consumer advocacy group Families USA, said the Supreme Court ruling beat back 'yet another challenge' to the Affordable Care Act (ACA) and was a win in terms of guaranteeing more access to care. "While this is a foundational victory for patients, patients have reason to be concerned that the decision reaffirms the ability of the HHS secretary, including our current one, to control the membership and recommendations of the US Preventive Services Task Force that determines which preventive services are covered,' Wright said. Religious Objection to HIV Prevention Treatment The case stems from a complaint filed by Braidwood Management, a Christian-owned firm objecting to how a provision of the 2010 ACA has been implemented. The Texas firm wanted to exclude coverage of pre-exposure prophylaxis for HIV and other preventive health services for religious objections. The ACA requires coverage without copay for tests and treatments that get 'A' and 'B' ratings from the USPSTF. The USPSTF has issued recommendations with these top marks for more than 40 tests and treatments, noted Justice Brett Kavanaugh in the majority opinion in this case. Services with current 'A' and 'B' ratings from USPSTF include cancer and diabetes screenings, nicotine patches for adults trying to quit smoking, statin medications to reduce the risk of heart disease and stroke, and physical therapy to help the elderly avoid falls, he wrote. Major Medical Groups Applaud Ruling The American Medical Association, the American Academy of Family Physicians, the American Cancer Society, and about 30 other patient and medical professional organizations applauded the Supreme Court decision in a joint statement Friday. In February, these groups had filed a brief with the Supreme Court, arguing in favor of the mandate. In it, these groups said almost 152 million people in the US were able to get access to preventive services without cost sharing in 2020 due to the mandate. Reducing insurance coverage for preventive services would 'lead to worsening patient outcomes, resulting in preventable deaths, and creating higher long-term medical costs,' said the groups in the brief. The key question before the Supreme Court in this case focused on the view of authority of the USPSTF. In the majority opinion, Kavanaugh said the plaintiffs sought to portray the USPSTF as an independent agency wielding 'unchecked power in making preventive-services recommendations of great consequence for the healthcare and health-insurance industries and the American people more broadly.' In fact, those challenging the ACA mandate asserted that, with respect to preventive-services recommendations, the Task Force members were 'more powerful' than even the US president or the secretary of the HHS, Kavanaugh wrote. That's not the case, Kavanaugh wrote in the majority opinion. Instead, the USPSTF members serve at the will of the secretary of the HHS, who can remove them, Kavanaugh noted. In addition, federal law allows the HHS secretary to directly review and block USPSTF recommendations before they take effect, Kavanaugh wrote. Some Reservations Family USA's Wright noted how HHS Secretary Robert Kennedy Jr recently replaced members of the CDC's independent vaccine advisory committee as an example of his concerns. The American Gastroenterological Association called the Supreme Court ruling 'positive news for patient care protections.' 'The ruling reiterates the authority that HHS has over the task force and its decisions, and we remain vigilant considering the secretary's recent actions to other expert panels,' the AGA said Friday in a statement. 'We will continue to work with our coalition partners and champions to ensure patients continue to have coverage of essential preventive screenings.' The ACA mandate also has helped make cancer screening more palatable to younger patients, which physicians note is especially important given that more cases seem to be occurring earlier in life. National Institutes of Health researchers recently reported that the incidence of 14 cancer types increased among people under age 50 between 2010 and 2019. 'To convince healthy people to undergo a test when they're feeling fine to prevent a cancer that might or might not develop years in the future, it requires reducing barriers and taking away copays and providing insurance coverage,' Jatin Roper, MD, an assistant professor of medicine at Duke University and AGA spokesman, told Medscape in recent interview. Roper reported no relevant financial disclosures.
NBC News
18 hours ago
- Health
- NBC News
By maintaining Obamacare pillar, Supreme Court hands win to HIV advocates
The Supreme Court on Friday granted the HIV-prevention field a historic win — yet with a major caveat — as it upheld a federally appointed health task force's authority to mandate no-cost insurance coverage of certain preventive interventions, but clarifying that the Health and Human Services secretary holds dominion over the panel. The 6-3 decision in Kennedy v. Braidwood Management, Inc. essentially leaves in place a popular pillar of the Affordable Care Act, which mandates that most insurers cover various task force-recommended preventive screenings, therapies and interventions, with no out-of-pocket costs imposed on patients. The case reached the high court after a group of Christian businesses in Texas objected to being compelled to cover a certain drug used for HIV prevention, known as PrEP, given their claims that it 'promotes homosexuality.' 'Since our efforts to address HIV in the U.S. are under attack on so many levels, preserving insurers' requirement to cover preventive services, including PrEP, will help ensure access to people who need it,' said Carl Schmid, executive director of the HIV + Hepatitis Policy Institute, a patient advocacy group in Washington, D.C. But the court clarified the scope of the task force's independence, thus potentially compromising its impact. Addressing concerns that the 16-member volunteer task force's power over insurers was unconstitutional, the justices asserted that the health secretary holds the authority to appoint and dismiss the panelists and to block their new recommendations from mandating insurance coverage. The secretary could also possibly direct the panel, including one stocked with his or her own hand-picked members, to revisit previous recommendations that have already gone into effect. Given the unpredictable nature and unconventional approach to health policy of the current health secretary, Robert F. Kennedy Jr., HIV advocates are concerned that he might undermine the task force's current or future endorsements of HIV-prevention medications, known as PrEP. The ruling 'is a victory in the sense that it leaves intact the requirement to cover task-force recommendations,' said attorney Richard Hughes, a partner with Epstein Becker Green in Washington, D.C., who represented a group of HIV advocacy organizations in submitting a friend-of-the-court brief in the casel. 'It was always going to be a double-edged sword, as the political accountability that salvaged its authority comes with the ability to alter its recommendations.' The U.S. has secured only a modest decline recently in HIV cases, and HIV advocates stand at a crossroads amid the Trump administration's dramatic withdrawal of support for their cause. Promisingly, the Food and Drug Administration last week approved a long-acting injectable form of PrEP, Yeztugo, made by Gilead Sciences. Injected every six months, Yeztugo overwhelmingly bested Truvada, a daily-pill form of PrEP also made by Gilead, at lowering HIV transmissions in clinical trials. But Yeztugo has debuted as the Trump administration is gutting the Centers for Disease Control and Prevention's HIV-prevention division and after it canceled scores of HIV-related research grants. HIV experts have warned that this upheaval could lead HIV to rise again. Kennedy v. Braidwood Management, Inc. The plaintiffs' initial religious-liberty complaint was ultimately dropped from the case. The court more narrowly considered the constitutionality of an ACA provision that lent effective authority to a longstanding volunteer medical task force to mandate no-cost insurance coverage to preventive interventions that the expert group rated highly, including PrEP. The plaintiffs argued that because the task force was not appointed by the president and confirmed by the Senate, granting it such power over insurance markets violated the Constitution's appointments clause. The justices grappled with the task force's balance of independence versus accountability. In particular, they sought to determine whether the task force members were appointed by the Senate-confirmed Health and Human Services secretary. In addition to PrEP, the task force has issued high scores, for example, to screening for lung cancer, diabetes, and HIV; treatment to help quit smoking; and behavioral counseling to prevent heart disease. Had the Supreme Court fully sided with the plaintiffs, insurers would have been free to drop such popular benefits or, at the very least, to impose related co-pays and other cost sharing. Writing for the majority, Justice Brett Kavanaugh found that the health secretary has the power 'to appoint Task Force members, and no statute restricts their removal.' He was joined by an ideological mix of colleagues, including Chief Justice John Roberts and Justice Amy Coney Barrett on the right, and Justices Sonia Sotomayor, Elena Kagan and Ketanji Brown Jackson on the left. Concerns and uncertainty about Kennedy HIV advocates expressed concern that Kennedy might undo the task force's recommendation for PrEP, or at the least deprioritize ensuring that Yeztugo receives a clear coverage mandate. Earlier this month, Kennedy dismissed the entire CDC Advisory Committee on Immunization Practices, or ACIP, and replaced them with his own hand-picked selections, including one notable anti-vaccine activist. At the first meeting of the newly formed committee this week, ACIP dropped recommendations for some flu vaccines over claims, widely debunked by researchers, that one ingredient in them is tied to autism. Mitchell Warren, executive director of the HIV advocacy nonprofit AVAC, expressed concern about 'what happened with the CDC ACIP this week, as it could be a harbinger of what a secretary of HHS can do to twist committees and task forces that should be composed of experts guided by science to ones that are guided by ideology and politics.' In an email to NBC News, Carmel Shachar, faculty director of the Health Law and Policy Clinic at Harvard Law School, characterized Kennedy's potential approach to overseeing the health task force as unpredictable. 'RFK has been skeptical of the medical approach to HIV/AIDS in the past, and that may color his attitude to revising PrEP guidance,' Shachar said. HHS did not immediately respond to a request for comment about the HIV advocates' concerns. In 2019, the health task force granted Truvada as PrEP a top rating. The drug was already widely covered by insurers. But under ACA rules, the task force's recommendation meant that by January 2021, insurance plans needed to cease imposing cost-sharing for the drug. The Centers for Medicare and Medicaid Services, or CMS, then clarified that insurers were also forbidden to impose cost sharing for the quarterly clinic visits and lab tests required for a PrEP prescription. A CDC study published in October found that about 200,000 people were using PrEP at any point in 2023. In 2019, the FDA approved another Gilead daily pill, Descovy, for use as PrEP. In late 2021, ViiV Healthcare's Apretude — an injection given every two months — was also green lit. The health task force gave top ratings to both of the newer forms of PrEP in 2023, which triggered a mandate for no-cost coverage to begin in January. A generic version of Truvada emerged in 2020 and now costs as little as $30 per month. The list prices of the three brand-name PrEP drugs range from about $2,200 to $2,350 a month. How the court's ruling could play out for HIV prevention Were Kennedy to appoint task force members who ultimately voided the PrEP coverage mandate, generic Truvada, at the very least, would still likely remain widely covered by insurance. But insurers would be free to demand cost-sharing for all forms of PrEP, including for required clinic visits and lab tests. And they could restrict access to the more expensive versions, including by imposing prior authorization requirements and higher cost sharing. Research suggests that even a small increase in monthly out-of-pocket costs for PrEP can depress its use and that those who accordingly forgo a prescription are especially likely to contract HIV. Johanna Mercier, Gilead's chief commercial officer, said even before the health task force's 2023 insurance mandate for Descovy went into effect in January, the drug's coverage was still pretty solid. Private insurers provided unrestricted coverage of Descovy for PrEP to 74% of commercially insured people, and 40% of prescriptions for the drug had no co-pay. After the mandate went into effect — including after CMS released a clarification on the PrEP-coverage mandate in October — those rates increased to 93% and 85%, respectively. This experience, Mercier said, has left the company optimistic that an increasing proportion of health plans will cover Yeztugo during the coming months. Health-policy experts are not certain whether the existing PrEP rating from the task force automatically applies to Yeztugo, or whether the drug will require its own rating to ensure coverage comes with no cost sharing. If Apretude's history is any guide, a requirement for Yeztugo to receive a specific rating could delay a no-cost insurance-coverage mandate for the drug from going into effect until January 2027 or 2028. It's also possible that CMS could release guidance clarifying that the existing mandate for PrEP coverage applies to Yeztugo, which would likely have a more immediate impact on coverage. However, Elizabeth Kaplan, director of health care access at Harvard's Health Law and Policy Clinic, said in an email that 'given this administration's and RFK's stated priorities,' the publication of a guidance on Yeztugo coverage by an HHS division 'appears unlikely.'
The Guardian
18 hours ago
- Health
- The Guardian
US supreme court ruling sets stage for more politicized science under RFK Jr
A US supreme court decision affirming the constitutionality of Obamacare sets the stage for more politicized science in the future, health law experts said about the court's decision. The court's majority opinion in Kennedy v Braidwood Management found that an expert panel – the preventive services taskforce – convened under the Affordable Care Act is under the direct oversight of the health secretary. 'This is your classic good news, bad news,' said Lawrence Gostin, a professor of global health law at Georgetown Law. 'In a sane world, with a secretary of health that believes in science and doesn't bring in conspiracy theories and agendas, you would applaud this decision.' With health policy now in the hands of the Trump administration, 'it gives Secretary [Robert F Kennedy Jr] complete power about what to recommend and what not to recommend,' Gostin said. The court issued the opinion only hours after an expert vaccine advisory panel (ACIP) handpicked by Kennedy subverted the scientific consensus by recommending against thimerosal-containing vaccines, a preservative overwhelmingly considered safe. Thimerosal has been a subject of misinformation and anti-vaccine advocacy for decades. Much like the expert panel in question in the Braidwood case, the recommendations of the vaccine advisory committee are a key link in the treatment distribution pipeline. Recommendations from both panels are typically affirmed by the leadership of the health department, and then become the basis on which insurers base coverage decisions. In the case of the ACIP, those recommendations typically concern vaccines. In the preventive taskforce context, they include a wide range of treatments – from statins to cancer screenings to HIV prevention. It was widely recognized that Kennedy had the authority to hire and fire people for the vaccine panel – but legal controversy existed about whether health secretaries have the same power over the preventive services taskforce. 'The president and the Senate are accountable 'for both the making of a bad appointment and the rejection of a good one,'' wrote Justice Brett Kavanaugh for the six-vote majority. In other words, the court said, if you don't like it, go to the ballot box. MaryBeth Musumeci, an associate professor of health law management at the George Washington University Milken Institute of Public Health, told the Guardian: 'We have that structure in place – and that is a really great structure if the folks in charge are actually deferring to the experts and the science and what the evidence says.' She added: 'To the extent that we are going to make decisions based on bad science – that has really serious public health implications.' The panel at the center of the vaccine decision is the ACIP vaccine panel. Until June, the advisory panel was made up of 17 experts vetted by CDC career scientists. Their recommendations, while not binding, were almost always approved by CDC leadership. Kennedy fired all 17 members unilaterally in June and stocked the panel with eight ideological allies – including vaccine skeptics and medical professionals with little experience in vaccines. One panelist withdrew after a government financial review, and after it was widely publicized that the secretary's claims about the panelist's affiliation with two universities was false. Wayne Turner, a senior attorney for the National Health Law Program, which advocates for the medically underserved, said that he and others were 'certainly breathing a sigh of relief with the court's decision today' because a key provision of Obamacare was found to be constitutional. 'But that sigh of relief is really short-lived,' Turner said. 'We have long-anticipated with the appointment of RFK Jr, and certainly with his actions with the ACIP, that we can fully expect the preventive services taskforce to be the next battleground in the ideological war this administration seems to be waging. And the war is against science.' The subject of the Braidwood case provides a salient example. Plaintiffs were suing the government to claim that the taskforce was wrongly appointed. Although their legal argument was thorny, one treatment they specifically cited as wrong was insurance coverage of pre-exposure prophylaxis (Prep), an HIV prevention drug. Although the plaintiffs' claim that the taskforce was unconstitutional was swatted down, it provides activists with a roadmap to get what they want – if they can convince Kennedy to appoint more ideological allies to the taskforce. The preventive services taskforce may have one protective mechanism: a requirement that they be guided by evidence written into Obamacare, the legislation that impaneled them. Gearing up for another fight, Turner said: 'That's going to be an important thing for us to point to in the weeks and months ahead, and years, quite frankly.'
CNBC
a day ago
- Health
- CNBC
Supreme Court endorses Obamacare panel that requires free preventive care
WASHINGTON — The Supreme Court on Friday rejected a challenge to an Affordable Care Act provision that set up a panel to recommend preventive care services that insurers must provide at no cost to patients. The court, split 6-3, ruled in favor of the Trump administration, which was defending the law, saying the task force members are lawfully appointed under the Constitution's appointments clause. The task force members are under the supervision of the health and human services secretary, a position held by Robert F. Kennedy Jr., which addresses any concerns that it is not accountable to the executive branch, the court found in an opinion written by Justice Brett Kavanaugh. The task force members' appointment is "fully consistent" with the Appointments Clause, Kavanaugh said. He also noted that Kennedy can fire the task force members at any time and has the authority to review their recommendations. Three conservative justices dissented. The case arose from a challenge brought by Christian employers Braidwood Management and Kelley Orthodontics, in addition to several individuals, who objected on religious grounds to the U.S. Preventive Services Task Force's approval of no-cost coverage for the HIV prevention medication known as pre-exposure prophylaxis, or PrEP. The plaintiffs asserted that their religious rights were violated "by making them complicit in facilitating homosexual behavior, drug use, and sexual activity outside of marriage between one man and one woman." But by the time the case reached the Supreme Court, the legal issue was not the religious question raised under the Constitution's First Amendment, focusing solely on the appointments issue. The U.S. Preventive Services Task Force recommends a wide array of preventive services related to such issues as cancer, diabetes and heart disease. The challengers said the structure of the task force was unlawful because members were not properly appointed via a presidential nomination and Senate confirmation. They added that the panel's members are intended to be independent and not under the control of the health and human services secretary as the government argued. The panel, composed of outside experts, has 16 members and was formed as an independent body appointed by the federal official who heads the Agency for Healthcare Research and Quality. The dispute is the latest to reach the Supreme Court over the 2010 health care law — then-President Barack Obama's signature legislative achievement — which Republicans have regularly attacked in court and sought to repeal. This time, the Trump administration defended the provision in question after having taken over the case from the Biden administration. The lawsuit was filed in 2020, leading to a federal judge in Texas issuing a ruling that said the structure of the task force was unconstitutional and all of its decisions should be considered invalid nationwide. The New Orleans-based 5th U.S. Circuit Court of Appeals narrowed that ruling somewhat last year. The Biden administration then took the case to the Supreme Court. The Supreme Court has a 6-3 conservative majority that has regularly weakened the power of federal agencies.
NBC News
a day ago
- Health
- NBC News
Supreme Court endorses Obamacare panel that requires free preventive care
WASHINGTON — The Supreme Court on Friday rejected a challenge to an Affordable Care Act provision that set up a panel to recommend preventive care services that insurers must provide at no cost to patients. The court, split 6-3, ruled in favor of the Trump administration, which was defending the law, saying the task force members are lawfully appointed under the Constitution's appointments clause. The task force members are under the supervision of the health and human services secretary, a position held by Robert F. Kennedy Jr., which addresses any concerns that it is not accountable to the executive branch, the court found in an opinion authored by Justice Brett Kavanaugh. The task force members' appointment is "fully consistent" with the Appointments Clause, Kavanaugh said. Three conservative justices dissented. The case arose from a challenge brought by Christian employers Braidwood Management and Kelley Orthodontics, in addition to several individuals, who objected on religious grounds to the U.S. Preventive Services Task Force's approval of no-cost coverage for the HIV prevention medication known as pre-exposure prophylaxis, or PrEP. The plaintiffs asserted that their religious rights were violated 'by making them complicit in facilitating homosexual behavior, drug use, and sexual activity outside of marriage between one man and one woman." But by the time the case reached the Supreme Court, the legal issue was not the religious question raised under the Constitution's First Amendment, focusing solely on the appointments issue. The U.S. Preventive Services Task Force recommends a wide array of preventive services related to such issues as cancer, diabetes and heart disease. The challengers said the structure of the task force was unlawful because members were not properly appointed via a presidential nomination and Senate confirmation. They added that the panel's members are intended to be independent and not under the control of the health and human services secretary as the government argued. The panel, composed of outside experts, has 16 members and was formed as an independent body appointed by the federal official who heads the Agency for Healthcare Research and Quality. The dispute is the latest to reach the Supreme Court over the 2010 health care law — then-President Barack Obama's signature legislative achievement — which Republicans have regularly attacked in court and sought to repeal. This time, the Trump administration defended the provision in question after having taken over the case from the Biden administration. The lawsuit was filed in 2020, leading to a federal judge in Texas issuing a ruling that said the structure of the task force was unconstitutional and all of its decisions should be considered invalid nationwide. The New Orleans-based 5th U.S. Circuit Court of Appeals narrowed that ruling somewhat last year. The Biden administration then took the case to the Supreme Court. The Supreme Court has a 6-3 conservative majority that has regularly weakened the power of federal agencies.
