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CNN
8 hours ago
- Health
- CNN
Challenge to panel that recommends no-cost preventive health care is rejected by Supreme Court
The Supreme Court on Friday upheld a task force that recommends preventive health care services that insurers must cover at no-cost, turning away the latest legal challenge to Obamacare to reach the high court. The opinion indicated that the panel's recommendations – including pre-exposure prophylaxis, or PrEP, a medication which vastly reduces a person's risk of getting HIV from sex or injection drug use – would remain in effect, some experts said. However, the case is being remanded to a lower court, where the recommendations could be challenged again. Though the appeal never threatened to take down the Affordable Care Act, it could have had a sweeping impact on millions of Americans and their access to preventive services. Keeping the cost of preventive care free makes it more likely that people will get screenings and other services that are aimed at detecting disease at an earlier stage. 'This is a big win for preventive services,' Andrew Twinamatsiko, a director of the Center for Health Policy and the Law at Georgetown University's O'Neill Institute. 'Over 150 million people have been able to access preventive services because of this provision. So this decision ensures that they can keep accessing those services without cost sharing, which is good for health and for minimizing death and disease.' The Supreme Court ruled that members of the panel are 'inferior' officers, meaning they do not need to be appointed by the president. The ruling confirms Health and Human Services Secretary Robert F. Kennedy Jr., and his predecessor in the Biden administration, had the ability to name the experts who sit on the panel. Justice Brett Kavanaugh wrote the opinion for a 6-3 majority that included both liberal and conservative justices. The 16-member US Preventive Services Task Force, made up of volunteers, has since 1984 provided recommendations to the government about preventive services – like cancer screenings and statin medications to help reduce the risk of heart disease – that can improve Americans' health. As part of the nationwide health care law enacted 15 years ago during President Barack Obama's administration, those recommendations are used to determine which services insurers must cover without charge. At issue in the case were newer recommendations the panel made after the Affordable Care Act was enacted in March 2010. Preventive services recommended before then were not at stake, nor were certain immunizations and preventive care for women and children, which are recommended by other government entities. The more recent recommendations include lung cancer screenings for certain adults, hepatitis screenings and colorectal cancer screenings for younger adults, according to a brief submitted in the case by Public Citizen and several public health groups. Physical therapy for certain older adults to help prevent falls and counseling to help pregnant women maintain healthy body weights are also among the other newer recommendations. A leading health insurance industry group said policies won't change, at least for the time being. 'With this ruling, there are no impacts to existing coverage, and we will closely monitor the ongoing legal process,' AHIP, formerly America's Health Insurance Plans, said in a statement. The Supreme Court's ruling comes at a time when Kennedy has started exerting his authority over panels that offer health care recommendations for the public. Earlier this month, he removed all 17 members of the US Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices, which guides the federal government's vaccine recommendations, and then added eight new ones. The move has sparked concerns that the new panel's recommendations could be more in line with the views of Kennedy, who has a history of vaccine skepticism. 'The big takeaway here is that the Task Force's recommendations are binding, just as the ACA's drafters intended,' Nicholas Bagley, a law professor at the University of Michigan, posted on X. 'BUT the scheme is constitutional only because Sec Kennedy can exercise near-complete control over Task Force recommendations. A mixed bag!' The task force structure was challenged by a Texas business, Braidwood Management, that objected on religious grounds to covering certain preventive services, including PrEP. Braidwood argued that, under the Constitution, task force members must be appointed by the president with Senate confirmation. At the very least, the company said, Congress needed to affirmatively vest the appointment power in the secretary of the Department of Health and Human Services. Before 2023, the task force members were appointed by the director of the Agency for Healthcare Research and Quality, or AHRQ, an agency that is part of HHS. The case, on appeal from the conservative 5th US Circuit Court of Appeals, created an unusual political dynamic. Though initially appealed by the Biden administration, President Donald Trump's administration has defended the task force since taking power this year – despite the president's years-long campaign to repeal the 2010 health care law. On the other side of the litigation, Braidwood was represented at the Supreme Court by Jonathan Mitchell, a veteran conservative lawyer who successfully argued against an effort in Colorado to remove Trump from that state's primary ballot during last year's election. The fight over Braidwood's religious objections to PrEP were spun off into separate proceedings. The dispute at the Supreme Court focused on the Constitution's appointments clause, which establishes the president and Senate's role in appointing and confirming officials that wield significant government power. The Trump administration argued that the task force members were 'inferior officers,' because they could be removed at-will by the HHS secretary and because the department appeared to have at least some oversight of the group's recommendations. But if that's true, Mitchell pointed out, then its members needed to be appointed by the secretary of the department, not the director of a subagency. The law is unclear on who actually appoints the board noting and notes only that the AHRQ should 'convene' the group. The Department of Justice said that, through a series of other congressional actions, the secretary effectively had the power to appoint the task force since the position oversees the AHRQ director. During the course of the litigation, then-HHS Secretary Xavier Becerra 'ratified' the earlier appointments during the Biden administration, but Braidwood argued that move wasn't enough to overcome the fact that the law doesn't specifically vest the power of appointment in his office. The 5th Circuit sided with Braidwood, ruling that members of the task force are 'principal officers' who must be appointed by the president and confirmed by the Senate. Kennedy v. Braidwood was the fourth major appeal to reach the Supreme Court involving Obamacare since the law was enacted during Obama's first term and became a target for conservatives. In 2021, the high court ruled that conservative states challenging a key provision of the law did not have standing to sue because they were not directly harmed. The conservative court also rejected challenges to other provisions of Obamacare in 2012 and 2015.
Axios
15-04-2025
- Health
- Axios
Trump administration moves to limit trans care in ACA plans
The Trump administration is seeking to limit coverage of gender-affirming care for adults and minors in Affordable Care Act marketplace health insurance plans beginning next year. Why it matters: The rule, if finalized, would not ban marketplace plans from covering gender-affirming care services. But it could raise out-of-pocket costs for patients, add administrative burdens for insurance companies and inject confusion into state operations, health policy experts say. "It's a clear signal that, certainly, the federal government would not be looking to ensure that coverage is not discriminatory, as it has been doing before," said Katie Keith, director of the Center for Health Policy and the Law at Georgetown University. Catch up quick: The Centers for Medicare and Medicaid Services last month proposed stopping non-grandfathered individual and small group market plans from covering what it calls "sex-trait modification services" — a reference to gender-affirming care — as an essential health benefit. Essential health benefits are services that have to be offered to all marketplace enrollees with limits on out-of-pocket costs. If finalized, the change would go into effect for 2026 coverage. The proposal is part of a larger package that would roll back several Biden-era flexibilities to ACA plans that made health insurance easier to access. The proposal doesn't define the term "sex-trait modification," saying that not adopting a definition is standard with other restrictions on essential health benefits. But it indicates that the term references treatments including puberty blockers, hormone therapies and surgical operations. Zoom out: This is just one recent move from the Health and Human Services Department that takes aim at health coverage for gender-affirming care. CMS sent a separate letter to Medicaid directors last week that essentially requests states stop covering gender-affirming care for minors. Gender-affirming care is supported by major medical organizations, including the American Medical Association, the American Academy of Pediatrics and the American Psychiatric Association, which all concur it is medically necessary and can be lifesaving care. State of play: California, Colorado, New Mexico, Vermont and Washington currently cover gender-affirming care services as essential health benefits in their benchmark plans. Six other states don't explicitly include or exclude the services in their benchmarks, while 40 states exclude the services, per the proposed rule. Preventing states from including the care as an essential health benefit could increase costs for transgender enrollees in marketplace plans that do choose to keep covering gender-affirming care, according to an issue brief from KFF. Enrollees wouldn't be guaranteed the cost-sharing protections that they get with essential health benefits, and insurers wouldn't have to count gender-affirming care costs toward deductibles and out-of-pocket maximums. The proposal makes note of President Trump's executive order, currently halted by a federal judge, to defund gender-affirming care for minors. CMS says that regardless of whether the executive orders are allowed to be implemented, its proposal will remain viable because it's correcting what the agency sees as a regulatory deficiency: Employer-sponsored plans don't typically cover gender-affirming care services, and essential health benefits should be equal in scope to employer coverage, the agency claims. Reality check: It's not rare for employer-sponsored health plans to cover gender-affirming care. Nearly one-quarter of large employers reported covering the services in KFF's 2024 survey of employer benefits. Another 45% said they didn't know if their firm covered gender-affirming care. "Denying access to medically necessary care, especially for trans people of color and immigrant trans people, will only further increase health disparities and put lives at risk," Plume, a health clinic for transgender and gender-diverse people, wrote in a comment letter to CMS. Between the lines: Some health insurers said CMS should not finalize the proposal because it would be costly and operationally difficult for them. That's partly because gender-affirming care is made up of multiple services spanning different essential health benefit categories and used regularly for reasons outside of gender transitioning, the Association for Community Affiliated Plans wrote in comments to CMS. CMS should preserve the current framework that allows states to choose their own essential health benefit benchmark plans without overly prescriptive restrictions, health insurance trade group AHIP wrote in its own comments to the agency. What to watch: If CMS finalizes the policy, it could be challenged in court.
