ACA preventive care mandate under fire despite SCOTUS ruling

Modern Healthcare – Friday, August 8, 2025
By Bridget Early 

The battle over health insurance coverage of preventive medicine didn’t end at the Supreme Court in June.

The high court settled the question of whether health insurance companies and plan sponsors must fully cover interventions the U.S. Preventive Services Task Force recommends to the Health and Human Services Department. But other aspects of the requirement that prevention is offered without cost sharing still face legal and regulatory challenges that could impede access to vaccinations, contraceptives and more.

Beyond the courts, HHS Secretary Robert F. Kennedy Jr. is making sweeping changes to the U.S. Preventive Services Task Force and other advisory bodies tasked with assembling the lists of preventive services subject to the mandate from the Affordable Care Act of 2010.

Several federal entities share responsibility for deciding what preventive care is covered.

Under the oversight of the Agency for Healthcare Research and Quality, the U.S. Preventive Services Task Force focuses on screenings for cancer and other diseases and on medications such as pre-exposure prophylaxis, or PrEP, to prevent HIV infection.

The Health Resources and Services Administration proposes policies on preventive services for children, and the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices recommends what vaccines are covered.

The 6-3 Supreme Court decision in Kennedy v. Braidwood is limited to the U.S. Preventive Services Task Force’s role in the process. The court ruled that its recommendations are lawful.

But justices referred other parts of the case back to the lower courts. The plaintiffs — employers that espouse religious objections to contraception and PrEP — also challenged the authority of the HRSA and CDC panels.

The U.S. District Court for the Northern District of Texas ruled for the plaintiffs in 2023 and the U.S. Court of Appeals for the 5th Circuit partly affirmed that decision in 2024, prompting the Justice Department to appeal to the Supreme Court.

The 5th Circuit also ordered the district court to revisit parts of its ruling, but the case has been paused at that level since the high court took it up in January.

Proceedings will remain on hold until the 5th Circuit issues a ruling consistent with the Supreme Court’s and determines whether to remand any elements of the case to the district court.

The plaintiffs’ attorneys did not respond to a request for comment.

Lower courts have judgments to make, said Katie Keith, a director of the Center for Health Policy and the Law at the Georgetown University Law Center’s O’Neill Institute for National and Global Health Law.

Any ruling against the government could change what services are covered, Keith said. HRSA’s purview includes immunizations, routine height and weight measurement, bloodwork, and vision and hearing screenings for children and women’s preventive services such as contraception, breastfeeding services and supplies, diabetes screenings during and after pregnancy, and domestic violence screenings.

The case began during President Joe Biden’s term but the government maintained its defense after President Donald Trump took office in January.

HHS did not respond to a request for comment.

Inside HHS

By agreeing that the U.S. Preventive Services Task Force is a legitimate source of coverage dictates, the Supreme Court upheld the status quo in one sense.

Kennedy, however, has designs on significantly changing course. The high court’s decision essentially confirmed the Justice Department’s argument that the task force is subordinate to the secretary under the ACA.

The “Make America Healthy Again” advocate has already begun reshaping the advisory bodies behind the preventive services mandate.

Kennedy plans to replace U.S. Preventive Services Task Force members — as he did in June to the Advisory Committee on Immunization Practices — the Wall Street Journal reported, and he abruptly canceled a task force meeting last month.

Using the authority the Supreme Court declared he has, Kennedy could block new task force recommendations or rescind prior ones, such as for PrEP coverage, said Richard Hughes, a healthcare attorney at the law firm Epstein Becker Green.

In May, Kennedy did just that by rolling back recommendations from the Advisory Committee on Immunization Practices, triggering lawsuits.

“I expect that the secretary will follow a similar pattern, that we will see the removal of the task force members, that we will see interference with the processes of the task force, that we’ll see presentation of junk science, that we will see interference with its recommendations,” Hughes said.

The future of covering contraception as prevention is unclear because the first Trump administration shied away from disrupting access to birth control, which is a popular benefit, said Laurie Sobel, associate director of women’s health policy at the healthcare research organization KFF.

Although the first Trump administration broadened the exceptions for contraceptive coverage, it didn’t go further. This time, the administration may make other targeted changes, such as limiting coverage of emergency contraception, Sobel said.

The administration’s wide-reaching reorganization of HHS is also a factor. Among other things, the White House has proposed eliminating HRSA and AHRQ.

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