The Supreme Court on Monday is set to hear arguments in a case challenging a provision of the Affordable Care Act that requires private insurers to cover health care screenings, tests and checkups for free.
Experts say the court’s ruling in the case, called Kennedy v. Braidwood Management, could have sweeping consequences for patient access to preventive health care across the United States.
Since the ACA was passed in 2010, most insurers have had to cover a wide range of prevention services at no cost to patients — including cancer screenings, mammograms, statins for heart disease and HIV prevention medications.
About 150 million people are currently enrolled in private health insurance plans that cover free prevention services, according to KFF, a nonpartisan group that researches health policy issues. A KFF analysis found that 1 in 20 people — about 10 million people — received at least one prevention service in 2019.
“This is a really crucial case,” said Arthur Caplan, the head of the division of medical ethics at NYU Langone Medical Center in New York City, noting that many Americans say they can’t afford the high out-of-pocket cost of medical care. “The price will be paid in dead bodies if the court rules against.”
The lawsuit was filed in 2022 by a group of conservative Christian employers in Texas.
They argued that the ACA rule requiring them to cover the HIV prevention pill PrEP in their employee health plans violated their religious rights.
They also challenged the U.S. Preventive Services Task Force — an independent panel that recommends which preventive services insurers must cover — calling it unconstitutional because its members aren’t appointed by the president or confirmed by Congress.
Last year, the 5th U.S. Circuit Court of Appeals sided with the employers, but limited the decision to just the eight Texas companies involved in the case. The court declined to make the ruling apply nationwide.
The federal government, under the Biden administration, appealed the case to the Supreme Court. The Trump administration then told the court in February that it intended to defend the requirement.
What happens if Supreme Court rules against?
The Supreme Court is expected to make a decision sometime in June.
If the court strikes down the ACA rule, it would mean insurers could deny coverage for preventive services recommended by the task force, said Laurie Sobel, an associate director for women’s health policy at KFF.
“The recommendations would go back to March 2010,” Sobel said, referring to the year the ACA was enacted. Notable changes, she added, could include the starting age that most insurers cover colorectal cancer screens as well as coverage of PrEP. The current recommended age for colon cancer screening is 45, which the task force lowered from age 50 in 2021 and is credited with saving thousands of lives.
If the free preventive services requirement goes away, Richard Hughes, a health care attorney for Epstein Becker Green and lead counsel for the HIV+Hepatitis Policy Institute, said coverage could vary by insurance company.
“I think you’ll see some gradual erosion across the board,” Hughes said, referring to the services that insurers cover. “I think you’re going to see some restriction of access, you’re going to see cost sharing applied to certain services, and that’s been shown to be a barrier, because people are more inclined to walk away from a service when they’re presented with an out-of-pocket cost.”
It’ll also be harder to get people into the doctor’s office to seek preventive care, Sobel said. “Right now we can say, if you’re on a private health insurance plan … then you’re entitled to no cost sharing,” she said.
Even if the Supreme Court sides with the Trump administration, Sobel said, there are concerns about what Health Secretary Robert F. Kennedy Jr. could do to the task force.
In a court filing, the Trump administration said task force members “are inferior officers, because the Secretary of HHS — a quintessential principal officer — remains responsible for final decisions about whether Task Force recommendations will be legally binding on insurance issuers and group health plans.”
“Even a ruling in favor of the federal government doesn’t necessarily assure that the preventative services will remain how they are right now,” Sobel said.
Chronic conditions such as heart disease, cancer and diabetes are the leading causes of death and illness in the United States, according to the Centers for Disease Control and Prevention. A 2024 report from the Center for American Progress found the ACA rule has been linked to more Americans with better blood pressure, blood sugar levels and overall heart health. Other studies suggest it increased early-stage cancer diagnosis.
Caplan said he hopes Kennedy himself weighs in on the case.
“It doesn’t make any sense to keep talking about Make America Healthy Again while taking away preventive services,” he said.
A spokesperson for the Department of Health and Human Services did not immediately respond to a request for comment.
