Preventive Care Coverage Requirement Remains Intact After Supreme Court Decision

Action: On June 27, the Supreme Court upheld a key provision of the Affordable Care Act (ACA) allowing the U.S. Preventive Services Task Force to continue to determine which preventive services will be available free of cost under the law. As a result, most private health insurance plans must still cover a range of recommended preventive services without imposing a cost-sharing scheme such as copayments, deductibles, or co-insurance on patients.

Trusted Insights for What’s Ahead^®

• The USPSTF was first established in 1984 as “a scientifically independent, volunteer panel of national experts in prevention and evidence-based medicine.” The 16 members are appointed by the Secretary of Health and Human Services to 4-year terms and provide recommendations for a range of preventive services that include cancer screenings, pregnancy care, and testing for sexually transmitted diseases.
• Since 2010, the ACA’s preventive services provision mandates that private health insurance plans cover certain preventive care services. The ACA provides that the Secretary of Health and Human Services may appoint and dismiss members of the USPSTF and also block recommendations for mandatory preventive care coverage. In the current case, the Administration supported maintaining the provision.
• Aside from the USPSTF, the Advisory Committee on Immunization Practices, the Health Resources and Services Administration’s Bright Futures Project, and the HRSA-sponsored Women’s Preventive Services Initiative also issue recommendations for preventive services to be covered under the provision.
• While two lower courts found the method of appointing USPSTF members unconstitutional, the Supreme Court held, 6-3, that the method of appointment and the manner in which recommendations are adopted are constitutional.
• Patient advocacy groups applauded the ruling; similarly, the major health care industry association responded to the ruling by recognizing that upholding the requirement would have “no impacts to existing coverage.”
• This decision also impacts Medicare and Medicaid. Under the ACA, the Centers for Medicare & Medicaid Services (CMS) require these programs to cover the same preventive services mandated for private insurers—those recommended by the U.S. Preventive Services Task Force. As a result, beneficiaries will continue to receive key preventive care, such as screenings and immunizations, without cost-sharing.