Trump administration defends ACA preventive services

The Trump administration told the Supreme Court that it intends to defend the Affordable Care Act (ACA) requirement that insurers cover certain recommended preventive services at no cost to patients.

The details:

• Private insurers are required to cover preventive services, including cancer screenings, behavioral counseling, PrEP, etc., without cost sharing.
• Two Christian-owned companies and several individuals sued the federal government on religious freedom grounds in 2020 over whether their employer-sponsored insurance should have to cover certain preventive services (e.g., PrEP for HIV).
• A federal judge in 2022 ruled in favor of the companies and blocked the government from enforcing the requirement. But an appeals court last year overturned the nationwide injunction, only blocking the requirement for the companies and individuals who brought the case.
• Last month, the Supreme Court agreed to review the case. It will determine whether the requirement violates the Constitution because the list of services required to be covered is based on recommendations from the U.S. Preventive Services Task Force (USPSTF), whose members were not confirmed by the Senate.

What’s new: Trump’s Department of Justice wrote in a brief last week that it will maintain the Biden administration’s arguments in the case and defend the preventive services requirement.

• They said that there is no constitutional issue because USPSTF members cannot unilaterally make final decisions that are legally binding, and their recommendations only have a legal effect if the Department of Health and Human Services (HHS) secretary allows them to become final.
• The Biden administration had also argued that the USPSTF’s power derived from the health secretary, who retained a “supervisory role,” but the Trump administration is going further, arguing that HHS Secretary Robert F. Kennedy Jr. could order the task force to study a particular service or medication, remove any of its volunteer members who do not comply, ignore or delay review of their recommendations, or make sure they never see the light of day.
• The Biden administration’s defense of the law focused on the harm eliminating the requirement would cause tens of millions of people who would lose no-cost coverage of preventive services. The Trump administration brief largely avoids the human impact and instead stresses that USPSTF is constitutional because Kennedy’s power supersedes it.

The implications:

• If the Trump administration’s arguments win, preventive care would remain covered, but it would throw into doubt what qualifies.
• Given Kennedy’s views about preventive health care that often contradict the medical community’s consensus, and his reported desire to overhaul other HHS advisory committees, the Trump administration’s position worries some legal experts.
• Some ACA supporters say that the Trump administration’s decision to defend the preventive services requirement is more important than how they defend it.

Why it’s important: Mental health and drug/alcohol screenings are services included under the preventive services requirement and could be at risk.

What’s coming: The Supreme Court will review the case in the next few months.

Source: Trump administration to defend ACA preventive services mandate (Axios); Trump defends Obamacare at the Supreme Court – stressing RFK Jr.’s in charge now (Politico)