Supreme Court affirms cost waiving requirement for preventive care.
July 7
Summary: Employers will be required to continue to cover preventive services recommended by the USPSTF without cost sharing, and the Secretary of Health and Human Services (HHS) gained new control over the USPSTF.
The Supreme Court reaffirmed the Affordable Care Act requirement that employer-sponsored health plans provide coverage without cost sharing for the preventive services that receive an “A” or “B” rating from the U.S. Preventive Services Task Force. The Court also determined that the Secretary of Health and Human Services could dismiss USPSTF members and could accept or reject USPSTF recommendations.
Braidwood Management, a small company that describes itself as a “Christian company,” sued to invalidate the requirement to provide cost-free coverage to USPSTF-recommended preventiv servides. Braidwood claimed that the U.S. Preventive Services Task Force, with its members appointed by the Secretary of HHS, was unconstitutional because the Affordable Care Act gave it independent authority but members were not appointed by the President or subject to Senate confirmation. A district court and an appeals court had found in Braidwood’s favor.
The USPSTF is one of three authorities that recommend preventive services that must be covered without cost sharing.
The USPSTF makes recommendations for screening to detect cancer and other diseases, and medications to prevent diseases such as metastatic breast cancer and HIV. USPSTF recommendations were the subject of the late June Supreme Court ruling.
The Advisory Committee on Immunization Practices makes recommendations on vaccinations. The Secretary of Health and Human Services recently replaced all members of that committee.
The Health and Resources Services Administration (HRSA) recommends women’s and children’s health services, including screening, testing, prenatal care, contraceptives, and wellness examinations. HRSA has had substantial staff reductions this year, although a federal judge issued an injunction to halt the planned HHS reorganization.
Implications for employers:
The Supreme Court ruling means that current requirements to cover preventive care without cost sharing remain unchanged.
Some preventive services lower total medical claims cost, such as pediatric vaccinations and contraception. Most preventive services, like other medical care, leads to better health for a reasonable price, but does not lead to lower total medical expenses.
Here’s a link to a piece I wrote in StatNews this Spring on why employers should continue to cover preventive care without cost sharing regardless of the Supreme Court ruling.