Latest news with #PrEP
Yahoo
6 hours ago
- Health
- Yahoo
Supreme Court rejects conservative challenge to Obamacare health coverage
WASHINGTON − The Supreme Court on June 27 rejected the latest conservative challenge to the 2010 Affordable Care Act, an attack on free access to cancer screenings, drugs that prevent HIV, cholesterol-lowering medication and other preventive health care services. Two Christian-owned businesses and some people in Texas argued that the experts recommending some of the services health insurance must cover are so powerful that they must be appointed by the president and confirmed by the Senate. In a 6-3 decision, the Supreme Court disagreed, meaning a task force proposing these Obamacare services can continue to do so. But their ruling could give more power to Health and Human Services Secretary Robert F. Kennedy Jr. to decide which services must be available without copays or deductibles. "While today's ruling allows many Americans to breathe a sigh of relief, coverage for this vital care remains at risk," Zachary Baron and Andrew Twinamatsiko, directors of the Center for Health Policy and the Law, said in a statement. "All eyes will turn to the Trump administration to see if Secretary Robert F. Kennedy, Jr. directs the U.S. Preventive Services Task Force to revisit or issue new recommendations that could erode access to preventive care.' The benefit is one of the most popular provisions of the Affordable Care Act − commonly referred to as Obamacare − which has largely survived more than 2,000 lawsuits and multiple trips to the Supreme Court. The latest challenge came from Texans who objected to the requirement that insurers cover the HIV-prevention drug PrEP. They raised religious objections to the drug, saying it encourages same-sex relationships. A federal judge ruled the Christian businesses do not have to include PrEP in their insurance plans. But the judge also said the makeup of the U.S. Preventive Services Task Force, which recommended coverage of PrEP and other preventive services, violates the Constitution's appointments clause. The clause requires presidential appointment and Senate confirmation for officials in significant positions of authority – such as cabinet secretaries and other top agency officials. The Justice Department – both under the Biden and Trump administrations – fought back. The government argued it's the Health and Human Services secretary, and not the task force, that has the 'ultimate responsibility' for whether the experts' recommendations become final. The secretary can fire task force members, review their recommendations and prevent recommendations from taking effect, the Justice Department said during April's oral arguments. The attorney for the Christian businesses said the secretary doesn't have complete control over the task force. Under the law, he noted, tasks force members are supposed to be 'independent and, to the extent practicable, not subject to political pressure.' The government said that independence requirement merely means the task force is supposed to make recommendations based on their impartial medical and public-health judgments. The task force typically updates its recommendations every five years to account for medical advances or reflect new evidence of risk. For example, in 2021, the task force extended recommendations for colon cancer screening to people 45 and older, instead of 50 and up, because of increased diagnoses in younger people. Other services recommended since the ACA was passed include medications like statins to prevent heart disease, lung cancer screenings for certain adults, physical therapy for older people at risk of falling, and testing for hepatitis. Before Obamacare, Americans used preventive services at only about half the recommended rate, according to the federal government. Other services, such as vaccines, that are recommended by different experts, are in dispute under another aspect of the case that is still in the lower courts. This article originally appeared on USA TODAY: Supreme Court rejects conservative challenge to Obamacare
Yahoo
6 hours ago
- Health
- Yahoo
What the Supreme Court Obamacare decision means for RFK Jr.
The U.S. Supreme Court preserved a key element of the Affordable Care Act that helps guarantee that health insurers cover preventive care at no cost to patients. The justices reversed a lower court's ruling that the U.S. Preventive Services Task Force, which under the 2010 law has a major role in choosing what services will be covered, is composed of members who were not validly appointed. The suit started in Texas, where two Christian-owned businesses and individuals argued that health insurance plans they buy shouldn't have to cover medical tests and drugs they object to on religious grounds, such as the HIV-prevention drug PrEP. But the legal question at the heart of the Supreme Court case was whether the task force is so powerful that, under the Constitution, its members must be appointed by the president and confirmed by the Senate. Justice Brett Kavanaugh wrote for the 6-3 majority that Health and Human Services Secretary Robert F. Kennedy Jr. can remove task force members at will and can review their recommendations before they take effect. 'The Task Force members are removable at will by the Secretary of HHS, and their recommendations are reviewable by the Secretary before they take effect,' he wrote. 'So Task Force members are supervised and directed by the Secretary, who in turn answers to the President preserving the chain of command.' The Health and Human Services secretary has always appointed task force members and ratified their recommendations, said MaryBeth Musumeci, teaching associate professor of health policy and management at George Washington University's Milken Institute School of Public Health. But the ruling expanded on that authority by clarifying that the secretary also could remove members and block recommendations, she said. Given that Kennedy had recently fired all 17 original members of the Advisory Committee on Immunization Practices, another expert panel that issues health recommendations, Musumeci said 'there is reason to be worried.' The secretary has never removed access to preventive services that have been proven to help people stay healthy, nor has the secretary "sought to shape the membership of our expert panel in any way," task force chair Dr. Michael Silverstein said in a statement emailed to USA TODAY. 'While the HHS Secretary has long had authority over the USPSTF, historically they have only acted to increase access to preventive care, occasionally going beyond the evidence to secure enhanced coverage for preventive services," he said. "Given our shared focus on preventing cancer and chronic disease, we certainly hope that the Secretary will allow our current work to continue unimpeded, as it has thus far.' Surprise move? RFK Jr.'s vaccine committee votes to recommend RSV shot for infants Katherine Hempstead, senior policy officer at the Robert Wood Johnson Foundation, a health nonprofit, praised the high court's decision because it meant that millions of Americans still have access to preventive care such as mental health screenings, cancer screenings, STI testing and important medications. But she also called the ruling both an 'ending and a beginning.' 'It's the ending of the challenge, but now it's the beginning of something that's going to unfold where we're going to see someone exercise control over this expert panel that has very strong opinions about … many aspects of medical care,' she said. More details: Supreme Court rejects conservative challenge to Obamacare health coverage If Kennedy plans to target the preventive services task force, it's unclear what preventive services could be at risk, Musumeci said. But insurance companies ultimately have the final decision. Even if the secretary vetoes a new recommendation or revokes an existing one, insurance companies can still decide to cover the preventive service. America's Health Insurance Plans, a trade association representing health insurance companies, plans to closely monitor the legal process but affirms that the court's ruling will not affect any existing coverage, according to an emailed statement sent to USA TODAY. Contributing: Maureen Groppe and Bart Jansen, USA TODAY; Reuters. Adrianna Rodriguez can be reached at adrodriguez@ This article originally appeared on USA TODAY: Obamacare Supreme Court decision: What it means for RFK Jr.
NBC News
7 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.'
USA Today
7 hours ago
- Health
- USA Today
What the Supreme Court Obamacare decision means for RFK Jr.
The U.S. Supreme Court preserved a key element of the Affordable Care Act that helps guarantee that health insurers cover preventive care at no cost to patients. The justices reversed a lower court's ruling that the U.S. Preventive Services Task Force, which under the 2010 law has a major role in choosing what services will be covered, is composed of members who were not validly appointed. The suit started in Texas where two Christian owned business and individuals argued that health insurance plans they buy shouldn't have to cover medical tests and drugs they object to on religious grounds, such as the HIV-prevention drug PrEP. But the legal issue at the heart of the Supreme Court case was whether USPSTF is so powerful that, under the Constitution, its members must be appointed by the president and confirmed by the Senate. Justice Brett Kavanaugh wrote for the 6-3 majority that Health and Human Services Secretary Robert F. Kennedy Jr. can remove task force members at will and can review their recommendations before they take effect. 'The Task Force members are removable at will by the Secretary of HHS, and their recommendations are reviewable by the Secretary before they take effect,' he wrote. 'So Task Force members are supervised and directed by the Secretary, who in turn answers to the President preserving the chain of command.' The Health and Human Services Secretary has always appointed USPSTF members and ratified their recommendations, said MaryBeth Musumeci, teaching associate professor of health policy and management at George Washington University's Milken Institute School of Public Health. But the ruling expanded on that authority by clarifying that the secretary could also remove members and block recommendations, she said. Given that Kennedy had recently fired all 17 original members of the Advisory Committee on Immunization Practices, another expert panel that issues health recommendations, Musumeci said 'there is reason to be worried.' The secretary has never removed access to preventive services that have been proven to help people stay healthy nor have they "sought to shape the membership of our expert panel in any way," USPSTF chair Dr. Michael Silverstein said in a statement emailed to USA TODAY. 'While the HHS Secretary has long had authority over the USPSTF, historically they have only acted to increase access to preventive care, occasionally going beyond the evidence to secure enhanced coverage for preventive services," he said. "Given our shared focus on preventing cancer and chronic disease, we certainly hope that the Secretary will allow our current work to continue unimpeded, as it has thus far.' Surprise move? RFK Jr.'s vaccine committee votes to recommend RSV shot for infants Katherine Hempstead, senior policy officer at the Robert Wood Johnson Foundation, a health nonprofit, praised the SCOTUS decision because it meant that millions of Americans still have access to preventive care such as mental health screenings, cancer screenings, STI testing and important medications. But she also called the ruling both an 'ending and a beginning.' 'It's the ending of the challenge but now it's the beginning of something that's going to unfold where we're going to see someone exercise control over this expert panel that has very strong opinions about… many aspects of medical care,' she said. More details: Supreme Court rejects conservative challenge to Obamacare health coverage If Kennedy plans to target USPSTF, it's unclear what preventive services could be at risk, Musumeci said. But insurance companies ultimately have the final decision. Even if the secretary vetoes a new recommendation or revokes an existing one, insurance companies can still decide to cover the preventive service. America's Health Insurance Plans, a trade association representing health insurance companies, plans to closely monitor the ongoing legal process but affirms that the SCOTUS ruling will not impact any existing coverage, according to an emailed statement sent to USA TODAY. Contributing: Maureen Groppe and Bart Jansen, USA TODAY; Reuters. Adrianna Rodriguez can be reached at adrodriguez@
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.
