Medicare Rights, Partners Ask SCOTUS: Preserve Preventative Care Requirement in Braidwood

Last week, Medicare Rights Center joined with other members of the Chronic Illness and Disability Partnership and the Center for Health Law and Policy Innovation at Harvard Law School to submit an amicus curia, or friend of the court, brief to the Supreme Court of the United States.

The Braidwood Case Explained

Originally filed as Braidwood Management v. Becerra, the plaintiffs in this case challenged the Affordable Care Act (ACA) requirement that most private insurance plans cover preventative services without cost sharing. Judge Reed O’Connor ruled in March of 2023 that the ACA’s reliance on recommendations of the U.S. Preventative Services Task Force (USPSTF) violated the Appointments Clause of the U.S. Constitution. He also found that the ACA’s requirement to cover Pre-exposure Prophylaxis (PrEP) medications for HIV prevention infringes on plaintiff’s religious rights under the Religious Freedom Restoration Act.

On appeal, the Fifth Circuit largely upheld the decision with regard to the role of the USPSTF in determining mandatory preventative coverage. However, the circuit court did end the nationwide injunction, limiting the impact of the decision to the named plaintiffs.

The case history has been complex and “twisting”—with numerous cross appeals, but the questions before the Supreme Court at this point are whether the ACA’s reliance on the USPSTF is constitutional, whether the Secretary of HHS can “cure” any problems by affirmatively adopting the recommendations, and whether or not Secretary Becerra effectively did so. The court will also consider whether the district court should have just removed any unconstitutional portion of the law rather than barring enforcement broadly. It will not consider the question of whether the requirements for preventative service coverage based on the recommendations of other entities are constitutional.

What the Amicus Curiae Brief Said

Amicus curiae briefs are arguments submitted by people and organizations who, though they are not directly involved in a lawsuit, are expert in the subject matter or likely to be impacted by the decision. For Braidwood, the Medicare Rights Center and other organizations that serve and represent people with chronic illnesses and disabilities submitted a brief highlighting the importance of access to preventative care services. The brief argues that preventative care without cost sharing is an essential tool to address chronic illness and disability, to help individuals achieve better health outcomes and to reduce system-wide burdens of chronic illness. Medicare is the eventual insurer of the vast majority of Americans, so it has a strong interest in increasing the uptake of preventative care services among its future beneficiaries. Current and future premium-paying beneficiaries and taxpayers share this interest in avoiding healthcare burdens among future beneficiaries.

What’s Next

The Supreme Court is set to hear oral arguments in the case on April 21, 2025. If the court agrees with the earlier decisions and finds that the delegation of authority to the USPSTF is unconstitutional, impacted plans may remove coverage for services recommended by that group after March 10, 2010. Because recommendations before that date are referenced in the statute and, therefore, adopted by Congress, they are not subject to this challenge.

How quickly plans revoke coverage for these services would also depend on state law. Most insurance contracts are approved annually by state regulators, and there are limitations on mid-year changes. Some states may separately require coverage of preventative services under state law.