Obamacare covers cancer screening and cholesterol meds. Will the Supreme Court change that?

USA Today

19-04-2025

Obamacare covers cancer screening and cholesterol meds. Will the Supreme Court change that? The case focuses on Obamacare's preventative care requirement. Religious opponents say HIV medications, for example, would make them 'complicit in facilitating homosexual behavior."
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Robert F. Kennedy Jr. posts endorsement of measles MMR vaccine on X
Health and Human Services secretary, and vaccine skeptic, Robert F. Kennedy Jr. supports measles vaccine after visiting West Texas.
WASHINGTON − One of the most popular parts of Obamacare - free cancer screenings, cholesterol-lowering medication and diabetes tests - is facing scrutiny in a Supreme Court challenge to the landmark health insurance law that, 15 years in, continues to spark legal battles and political fights.
Two Christian owned businesses and some people in Texas argue that health insurance plans they buy shouldn't have to cover medical tests and drugs they object to on religious grounds. Having to pay for certain HIV-prevention medications, for example, would make them 'complicit in facilitating homosexual behavior,' they've said.
In a twist from the first Trump administration, which tried to kill Barack Obama's landmark health insurance law, Trump's Justice Department will defend the law when the high court takes it up on Monday.
While that shows support across ideological lines, increasing the likelihood that the Supreme Court won't side with the challengers, a victory could give the Trump administration the power to pick and choose the preventive measures it wants to cover and for whom.
'What happens after the case might be more important than how the Supreme Court rules,' said Laurie Sobel, associate director for Women's Health Policy at KFF, a nonpartisan health research organization.
`Folks will notice if this benefit is gone'
The requirement that health insurance plans cover - without copayments or deductibles - services that detect diseases and prevent illnesses from developing has been used by tens of millions of Americans since the 2010 Affordable Care Act became law.
The legal issue at the heart of the Supreme Court Obamacare case is whether one of the three groups of experts that recommends services health insurance must cover is so powerful that, under the Constitution, its members must be appointed by the president and confirmed by the Senate.
If the Supreme Court agrees with the Texas businesses that they are, health insurers would not be required to cover any of the care recommended by the U.S. Preventive Services Task Force after the ACA was enacted. (Other services, such as vaccines, that are recommended by different experts, are in dispute under another aspect of the case that is still in the lower courts.)
For example, in 2021, the task force extended recommendations for colon cancer screening to people 45 and older, instead of 50 and up, because of increased diagnoses in younger people.
'Folks will notice if this benefit is gone or if they're getting charged when they go to the doctor for their preventive care,' said Katie Keith, director of the Center for Health Policy and the Law at the O'Neill Institute for National and Global Health Law.
But if the court agrees with the Trump administration that the task force is controlled by the Health and Human Services Secretary, now Robert F. Kennedy Jr., coverage may also change. Kennedy could fire the task force and appoint members more hospitable to his agenda or impose his own decisions, experts said.
'I think the Trump administration's motivation here is to, as is always the case, to expand the power of the president and the Secretary of HHS,' said Tim Jost, a health law expert and professor emeritus at Washington and Lee University School of Law.
The task force typically updates its recommendations every five years to account for medical advances or reflect new evidence of risk.
Before Obamacare, Americans used preventive services at only about half the recommended rate, according to the federal government.
Obamacare has survived many challenges
The Affordable Care Act, Obama's signature domestic accomplishment, has been the target of more than 2,000 legal challenges and has reached the high court multiple times.
It was upheld in 2012, in 2015 and, most recently, in 2021, when the court dismissed another challenge to the law.
That suit started in the same federal district court in Texas that first heard the latest challenge, which critics say shows opponents of Obamacare were looking for a friendly judge.
U.S. District Judge Reed O'Connor in Texas said the conservativechallengers do not have to cover the HIV-prevention drug PrEP in their insurance plans because it's against their religious beliefs, a decision that is limited to the challengers and that the federal government has not appealed.
But O'Connor also agreed with the businesses that the task force violates the Constitution's appointments clause, which requires presidential appointment and Senate confirmation for officials in significant positions of authority – such as cabinet secretaries and other top agency officials.
The New Orleans-based 5th U.S. Circuit Court of Appeals backed that decision but reversed O'Connor's ruling invalidating the task force's recommendations for anyone but the challengers because of how the case was brought.
The Biden administration asked the Supreme Court to take the case to prevent a nationwide lawsuit, which the court agreed to do shortly before the new administration took office.
Trump administration is defending the law
Unlike an earlier legal challenge to Obamacare when the first Trump administration would not defend the law, the Justice Department in the second Trump administration is arguing the task force doesn't violate the Constitution.
The government says it's the Health and Human Services secretary, and not the task force, that has the 'ultimate responsibility' for whether the experts' recommendations become final. The secretary can deny a recommendation or delay it from going into effect so it can be reconsidered or modified, according to the Justice Department.
The challengers, however, point to a requirement that task force members and their recommendations 'shall be independent and, to the extent practicable, not subject to political pressure.'
'The Secretary does not have the power to remove task force members at will or to deny the recommendations because of the independence requirement,' lawyers for the challengers told the court. 'And even if he did, that would not be enough `direction' and `supervision' authority.'
The government counters that the independence requirement means the task force is supposed to make recommendations based on their impartial medical and public-health judgments.
'It does not mean that the Secretary is barred from then determining whether Task Force recommendations will be given legal effect,' the Justice Department told the Supreme Court.
And if the justices disagrees, they continued, then the court can strike down the 'shall be independent' directive and place the task force fully under the secretary's control.
No matter the outcome, public health advocates expect they will continue to have to fight for coverage of preventive services.
'I think that this is a first example of really testing the waters,' said Dorianne Mason, director of health equity for the National Women's Law Center. 'And I don't think that it will end with this.'