The Affordable Care Act will continue to provide free preventative services and medications to millions of people who rely on that provision of the law, the U.S. Supreme Court ruled June 27.
The 6-3 decision in Secretary of Health and Human Services v. Braidwood Management reversed a lower court ruling that appointments to the U.S. Preventative Services Task Force, which selects preventative services covered under the act, violate the Appointments Clause of the U.S. Constitution.
The challenge originated from a group of Texas-based Christian businesses and individuals objecting to the panel’s 2019 inclusion of a no-cost HIV-preventative medication.
The challenge originated from a group of Texas-based Christian businesses and individuals objecting to no-cost HIV-preventative medication.
In approving the medication, known as PrEP, the government also “violates their religious beliefs by making them complicit in facilitating homosexual behavior, drug use and sexual activity outside of marriage between one man and one woman,” the original action claimed.
Because companies with 50 or more full-time employees are required to offer health insurance, mandated participation amounted to “tacit endorsement” of those behaviors, the suit contended.
However, justices did not rule on the plaintiffs’ faith-based arguments, which are the subject of a separate claim under the Religious Freedom Restoration Act. Instead, the court’s opinion sided with the government that task force appointments by the secretary of Health and Human Services, rather than the president, are constitutional and that PrEP can remain in its lineup of no-cost medications.
“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,” Justice Brett Kavanaugh wrote for the majority, comprised of justices Amy Coney Barrett. Chief Justice John Roberts, Ketanji Brown Jackson, Elena Kagan and Sonia Sotomayor. “So task force members are supervised and directed by the secretary, who in turn answers to the president, preserving the chain of command in Article II.”
Practically, that means whether or not PrEP or any other no-cost preventative medications remain covered is solely up to current HHS Secretary Robert F. Kennedy, an outspoken opponent of vaccines and many pharmaceutical drugs.
Michael Silverstein
Task force chair Michael Silverstein said no secretary has ever barred the availability of no-cost medications or attempted to reshape the panel “in any way,” USA Today reported.
While secretaries always have had authority over the task force, “historically they have only acted to increase access to preventive care, occasionally going beyond the evidence to secure enhanced coverage for preventive services,” Silverstein 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.”
PrEP, which is available in at least two brand-name drugs, is a daily pill or occasional injection that has proved highly effective at preventing transmission of HIV. It was a game-changer in the gay male community, turning attention from solely treating HIV toward prevention of the disease.
Administration of the medication comes with often mandatory screenings every three months, which also has helped address the spread of other sexually transmitted infections, such as chlamydia and gonorrhea.
Some conservative evangelicals, however, do not want taxpayer or employer funds covering the antiviral medication because they believe access to it promotes promiscuity, just as some ultra-conservatives believe access to birth control pills promotes promiscuity among heterosexuals.
Experts in the field of sexually transmitted diseases applauded the Supreme Court’s decision.
“The Supreme Court’s ruling preserves one of our most powerful tools for fighting this nation’s epidemics of HIV and sexually transmitted infections: a system that guarantees insurance will cover the most basic preventive medical care,” said the National Coalition of STD Directors. “The basic STI screening and treatment services Americans access at their doctors’ offices every day are the most fundamental tools we have to keep preventable and treatable infections like chlamydia, gonorrhea, syphilis and congenital syphilis in check.”
However, the organization also acknowledged the ruling enables the Trump administration to actively reshape the task force and how it handles covered services: “We encourage Secretary Kennedy and the administration to preserve and expand the best practice, evidence-based STI screening and treatment recommendations for coverage by the USPSTF so American patients can protect themselves from epidemic STIs and access the essential care they need from their healthcare providers.”
In a separate case, Democracy Forward joined a coalition of public health professionals and small businesses in filing litigation to block the administration’s effort to eviscerate the Affordable Care Act, which provides more affordable medical insurance for individuals and families not covered by employer-sponsored plans.
“The lawsuit challenges a newly finalized rule that imposes surprise fees, weakens coverage standards and creates bureaucratic burdens for people trying to access ACA health insurance,” Democracy Forward said.
The rule adopted by the Centers for Medicare and Medicaid Services would cause 2.2 million Americans to lose health coverage.
“This unlawful rule will force families off their health insurance and raise costs on millions of Americans. This does nothing to help people — and instead harms Americans’ health and safety across our country,” said Skye Perryman, president of the legal and civil rights group.
Those cuts would be in addition to lower overall funding for the act under the budget bill passed by the U.S. Senate and now being considered in the House.
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