Trump Administration’s Message to Supreme Court Puts New Wrinkle in Braidwood Case

Preventive services covered by the Affordable Care Act (ACA) have been under fire for in recent years, as the requirement for private insurers to cover these services with no cost sharing has been left up in the air amid an ongoing lawsuit. The case, which was first decided in 2022 by a lower court, will go before the Supreme Court to decide whether the US Preventive Services Task Force (USPSTF) had the authority to regulate the preventive services covered under the ACA. With a new brief filed by the Trump administration, the case could become more complicated.

The Braidwood Management v Becerra lawsuit initially was brought with the argument that Braidwood Management was not required to cover services based on religious views.¹ This included pre-exposure prophylaxis (PrEP) for HIV, which private insurers were required to cover under the ACA. Braidwood Management argued that, under the appointments clause in the Constitution, the USPSTF did not have the authority to determine what services should be covered because the task force was not appointed by the Senate. The case is set to be decided by the Supreme Court later this year.

However, the Trump administration has now indicated in a new brief that it is willing to protect the preventive services measure of the ACA.² Of note, the Justice Department claims that it will be maintaining the arguments first brought by the Biden administration, which contended that the USPSTF members serve as inferior officers, with the HHS secretary was overseeing the decisions, meaning they need not be presidentially appointed and confirmed by the Senate.

The Trump administration indicated its intent to protect insurance coverage of preventive services | Image credit: yavdat - stock.adobe.com

The Trump administration is adding to the argument laid out by the Biden administration, stating that the HHS secretary has the final say in whether the USPSTF recommendations would have any legal effect.² The authority attributed to the HHS secretary could potentially include using their power of removal if there are delays in the process of making recommendations, denying a binding effect to the task force’s recommendations, and steering the USPSTF to focus on a particular service.³ The proposed reasoning for allowing USPSTF to continue giving recommendations would put more power in the HHS secretary’s hands, which could have major implications given newly confirmed secretary Robert F. Kennedy Jr’s stated beliefs surrounding public health, including his skepticism regarding vaccines and FDA policies.⁴

Regardless of the arguments used to keep the preventive services measure intact, experts say that requiring preventive services be covered under the ACA is important to patients across the country. More than 30 preventive services would be affected by a ruling against the legality of requiring insurance cover the services.⁵ Along with PrEP, the lawsuit could affect services such as screenings for colorectal cancer, HIV, hepatitis C, lung cancer, and vision in children aged 6 months to 5 years. The lawsuit could potentially roll back requirements to only cover preventive services given an A or B rating by the USPSTF prior to 2010, with all major changes since then not guaranteed coverage.

It remains to be seen how the arguments before the Supreme Court and its eventual decision could be affected by the new brief from the Trump administration. The HHS secretary could claim more authority over the USPSTF than before, which would have major implications for future preventive services being given A and B ratings that would force coverage from private insurers.

References

1. Bonavitacola J. Federal judge’s ruling throws preventive care access into question. AJMC^®. April 4, 2023. Accessed February 21, 2025. https://www.ajmc.com/view/federal-judge-s-ruling-throws-preventive-care-access-into-question
2. Bettelheim A. Trump administration to defend ACA preventive services mandate. Axios. February 20, 2025. Accessed February 21, 2025. https://www.axios.com/2025/02/20/trump-admin-defend-aca-mandate
3. Ollstein AM. Trump defends Obamacare at the Supreme Court—stressing RFK Jr.’s in charge now. PoliticoPro. February 21, 2025. Accessed February 21, 2025. https://subscriber.politicopro.com/article/2025/02/trump-obamacare-supreme-court-rfk-jr-00205261
4. Grossi G. 5 health policy stances of Robert F. Kennedy Jr. AJMC. November 15, 2024. Accessed February 21, 2025. https://www.ajmc.com/view/5-health-policy-stances-of-robert-f-kennedy-jr
5. Bonavitacola J. Braidwood case headed to Supreme Court, coverage for preventive care in jeopardy. AJMC. February 4, 2025. Accessed February 21, 2025. https://www.ajmc.com/view/braidwood-case-headed-to-supreme-court-coverage-for-preventive-care-in-jeopardy