Supreme Court to review Obamacare’s no-cost coverage of cancer screenings, heart statins and HIV drugs

CNN —
The Supreme Court said Friday it will review the constitutionality of the Affordable Care Act’s no-cost coverage mandates for certain preventive care services, putting the landmark health care law in front of the justices again just as President-elect Donald Trump – who tried to repeal the law during his first presidency – returns to the White House.
While not an existential threat to Obamacare, the case could imperil access Americans have to cost-free preventive treatments and services, including HIV prevention medications, heart statins and various screenings for cancers and other diseases.
The cost of some of these preventive services can be substantial, which would deter some people – particularly those with lower incomes – from accessing the care and slow the early detection of potentially deadly illnesses.
The 5th US Circuit Court of Appeals ruled that the mandates in question, based on the recommendations of the US Preventive Services Task Force, violated the Appointments Clause of the Constitution because its members are not appointed by the president with Senate confirmation. The 5th Circuit’s ruling was directed at no-cost coverage requirements implemented after Obamacare’s enactment in March 2010.
The appellate ruling only blocked the mandates as applied to the challengers of the specific case, a Texas business and several individuals. But both the Biden administration and the challengers agreed that the 5th Circuit’s precedent set the stage for another party to sue to block the mandates nationwide, and both sides had asked the Supreme Court to take up the case.
Among the other no-cost coverage mandates that are put at risk by the 5th Circuit ruling are prenatal nutritional supplements, physical therapy for older Americans to prevent falls and lung cancer screenings that, according to the Biden administration, could save the lives of 10,000 to 20,000 Americans a year.
A variety of other no-cost preventive services – such as well-baby visits and autism screenings for children, cervical cancer screenings and breastfeeding support programs for women, and flu, measles and chickenpox vaccines – are not at issue in the case.
Studies have shown the Obamacare mandate prompted an uptake in preventive services and narrowed care disparities in communities of color.
“Even modest out of pocket costs mean that people don’t end up seeking out these services,” Zachary Baron, a director of the O’Neill Institute’s Center for Health Policy and the Law at Georgetown University, told CNN. “They end up pushing things off as they’re trying to juggle various bills.”
‘Protections for millions’
In her petition that the Supreme Court take up the case, US Solicitor General Elizabeth Prelogar wrote that the 5th Circuit ruling “jeopardizes healthcare protections that have been in place for 14 years and that millions of Americans currently enjoy.”
“This Court’s review is warranted because the court of appeals has held an Act of Congress unconstitutional and its legal rationale would inflict immense practical harms,” she wrote, later adding that the justices should also take up the case because the appellate “decision threatens to disrupt a key part of the ACA that provides healthcare protections for millions of Americans.”
The challengers also urged the Supreme Court to take up the case, even as they argued that the 5th Circuit’s ruling was “well-reasoned and correct.” They pointed to the Supreme Court’s typical practice of granting cases where an act of Congress was deemed unconstitutional by a lower court.
The Texas business, Braidwood, sued over the mandates because the company had moral objections to covering the HIV prevention medications – known as PrEP. The company also objected to paying for insurance that covered screenings for sexually transmitted diseases and other treatments related to conduct the employer morally opposed.
The lawsuit was first filed in 2020, and at the time, the Trump administration defended the Affordable Care Act’s requirements.
Representing the company is Gene Hamilton, an alum of the first Trump administration Justice Department, who now, alongside Trump adviser Stephen Miller, leads the legal advocacy organization America First Legal. Also representing the challengers is Jonathan Mitchell, who argued on Trump’s behalf in the Colorado ballot access case before the Supreme Court last term.
This story has been updated with additional details.