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Forbes
07-07-2025
- Health
- Forbes
How RFK Jr. Could Disrupt Insurance Coverage Of Preventive Healthcare
The Affordable Care Act, aka Obamacare, includes provisions that guarantee a number of preventive ... More healthcare services at no cost to patients. In a recently decided case, the Supreme Court upheld the authority of the Secretary of Health and Human Services to appoint members of the United States Preventive Services Task Force, rather than requiring presidential nomination and corresponding Senate confirmation hearings and a vote. The Task Force is tasked with making key recommendations on which preventive healthcare services and technologies must be covered by health insurers by law. While this ruling preserves the current structure of the Task Force and ensures that its recommendations remain valid, it offers HHS Secretary Robert F. Kennedy Jr. broad latitude to reshape what's covered as he can hire and fire the expert panel, which in turn can lead to modified guidance. In the case before the court, the lead plaintiff, Braidwood Management, objected to the Affordable Care Act's requirement to cover HIV prevention medications, arguing that this mandate violated its religious beliefs. Braidwood further maintained that the Task Force is unconstitutional, specifically with regard to the procedure used to appoint members. The Task Force is in charge of recommending preventive healthcare services and technologies that ought to be covered by insurers, such as cancer screenings, cholesterol medications and HIV prevention drugs or pre-exposure prophylaxis, at no cost to patients. PrEP is a highly effective preventive medication for people who do not have HIV but are at high risk of exposure through sexual contact or injection drug use. It can be taken as a daily pill or as an injectable every two or six months. Under the ACA, PrEP products approved by the Food and Drug Administration must be reimbursed by insurers without any out-of-pocket charges to patients for the medications, clinic visits or laboratory tests. For the uninsured, there are programs available that can provide PrEP at reduced costs or for free. The Task Force's expert panel evaluates the best available scientific evidence to figure out whether a preventive health intervention is beneficial to patients. In the case of PrEP, soon after the first product was approved more than a decade ago, the Task Force recommended its coverage based on a review of the data submitted to the FDA. The Supreme Court ruled that the present structure of the Task Force is constitutional. As such, its decision reaffirms the ability of Kennedy to appoint and supervise officers under the aegis of the Department of HHS. But in light of Kennedy's evident distrust of established expertise and traditional scientific institutions in government decision-making, this could give pause. Besides holding vaccine-skeptic views, Kennedy has questioned whether HIV is the sole cause of AIDS, advocated on behalf of lifting of raw milk restrictions and removing flouride from drinking water. Challenging what he calls 'orthodoxies,' HHS Secretary Robert F. Kennedy Jr. has repeatedly made statements suggesting a skeptical viewpoint with respect to sole reliance on experts in making policy decisions, especially in the realm of public health. During an interview with Fox News, Kennedy said that 'trusting the experts is not a function of science or democracy, but of totalitarianism and religion.' What happened last month at the Advisory Committee on Immunization Practices, when the entire panel of experts was ousted and replaced, could offer clues as to how Kennedy may act, given that he has a similar authority to appoint and remove Task Force members. And this extends to his right to review and block their guidance before it takes effect. ACIP provides recommendations on vaccines to the Centers for Disease Control and Prevention. Positive advice for a vaccine implies health insurers must cover it free of charge. Kennedy oversees ACIP and can sack and appoint members. Kennedy dismissed the entire 17-member ACIP and appointed seven members to the advisory committee, several of whom have no vaccine or immunology pedigree while others include like-minded vaccine skeptics. It's unknown what changes the newly formed committee will recommend regarding scheduling of standard vaccinations. But it stands to reason that scheduling could be modified. Independently of ACIP, Kennedy has already made changes to COVID-19 vaccine policy, no longer recommending the vaccine to health children and pregnant women. STAT News reports that a lawsuit filed on July 7th alleges that 'HHS changed federal guidance outside of established processes, undermining trust.' And, earlier this year, another agency under Kennedy's control, the National Institutes of Health, dismantled the entire National Cancer Institute's Board of Scientific Advisors, which had 28 members. If something similar were to happen to the Task Force as what occurred to ACIP, experts suggest it could undermine the public and scientific community's trust in the panel and its recommendations. Moreover, it could result in restrictions in insurance coverage of certain preventive interventions.
Forbes
03-07-2025
- Politics
- Forbes
Stephen Miller: How America First Legal Influenced Supreme Court This Year
Trump advisor Stephen Miller has made headlines for spearheading many of the administration's most controversial policies, but his influence was also felt nearby at the Supreme Court during its most recent term, as the legal group he founded played a role in some of the court's biggest cases—underscoring how Miller has been able to shape right-wing politics beyond the executive branch. White House Deputy Chief of Staff Stephen Miller speaks to the media outside the White House on May ... More 30. Getty Images Miller—a top Trump official overseeing the government's immigration agenda—founded America First Legal, a right-wing legal group that has likened itself to a conservative version of the American Civil Liberties Union, bringing dozens of lawsuits since 2021 that advance right-wing interests. The group represented parties in one major case at the Supreme Court this term, Affordable Care Act dispute Kennedy v. Braidwood Management, and filed amicus briefs urging the court to take a particular position in five other argued cases. America First Legal and the White House confirmed to Forbes that Miller has not worked with the organization since joining the Trump administration in January. The Supreme Court cases reflect Miller's time at America First Legal, however: the organization had already filed at least one brief in a majority of its cases before the Supreme Court prior to Inauguration Day, and filings in two other cases came shortly afterwards in February. The group's president, Gene Hamilton, also previously served in the Trump administration as Deputy White House Counsel to President Donald Trump, though he left the White House to return to America First Legal in June. The Supreme Court largely sided with America First Legal in cases where it filed amicus briefs, but dealt a blow to the organization in the one case where it was a party, ruling against client Braidwood Management's effort to invalidate the task force deciding which preventive services are covered by insurance. Despite its loss in the Braidwood case, America First Legal was on the winning side of four cases it filed briefs in this term. The Supreme Court agreed with the group's arguments that the court should uphold state bans on gender-affirming care for minors, allow parents to opt their children out of being exposed to LGBTQ books in schools, rule in favor of a woman who argued she was discriminated against for being straight, and revive a lawsuit against the Palestine Liberation Organization. The fifth case the group weighed in on did not go in its favor, as the court rejected arguments that it should strike down the Federal Communications Commission's universal service obligation to provide telecom services to underserved communities. Who Is Stephen Miller? Miller is one of Trump's longest-serving advisors, initially joining his team during the 2016 presidential campaign and remaining at the White House throughout Trump's first term. After founding America First Legal during Joe Biden's presidency, Miller rejoined Trump as he returned to the White House, becoming the president's deputy chief of staff of policy. He's garnered the most attention and controversy for being a key architect of Trump's harsh immigration policy and mass deportations, with the advisor reportedly recently pushing immigration officials to meet a quota of at least 3,000 arrests per day. But Miller's influence over the White House and Trump's agenda is more wide-reaching, Bloomberg reports, with the advisor also overseeing issues like the Trump administration's attacks on top universities. 'He's probably as influential as any single person in the White House,' former House speaker Newt Gingrich told Bloomberg about Miller. America First Legal has praised the Supreme Court's rulings in cases that went its way this term, framing the court as siding with the organization after it filed briefs in each case. It touted one instance in which Justice Clarence Thomas noted the group's brief in his opinion concurring with the court's majority, claiming it reflected 'the unmistakable impact of America First Legal's ability to provide solid footing for the courts to uphold the rule of law for all Americans,' America First Legal Vice President Daniel Epstein said in a statement about the court's ruling in Ames v. Ohio Department of Youth Services. In that case, a woman claimed she was discriminated against for being straight. Miller has not commented on the court's rulings through America First Legal since joining the White House, though the Trump advisor has spoken out on social media and in media appearances in favor of several major decisions this term, such as the Supreme Court's ruling on transgender healthcare and the court's decision that restricted lower judges' ability to block Trump administration policies nationwide. 'With today's action, the Supreme Court has said President Trump can fully deliver on the mandate the American people gave him in November,' Miller told Fox News about the court's ruling on nationwide injunctions, which America First Legal did not participate in. Who's Bankrolling America First Legal? Tax filings show America First Legal has received sizable donations from a number of known groups that contribute to conservative causes since its founding in 2021, including the Bradley Impact Fund and Conservative Partnership Institute, where Trump's former White House Chief of Staff Mark Meadows holds a leadership role. The organization has also received more than $3 million from DonorsTrust, a donor-advised fund linked to conservative judicial activist Leonard Leo, whose groups have played a key role in right-wing lawsuits and judicial appointees. America First Legal received $1.5 million in 2023 from a foundation linked to Mike Rydin, a former construction software entrepreneur who's become a major conservative donor, helping Meadows' Conservative Partnership Institute expand its operations and buy real estate around Capitol Hill. Rydin is still helping to bankroll America First Legal, as the group is now advertising the donor will match up to $2 million in donations through the end of July. Tax filings have not yet been released showing how much America First made in 2024 or so far in 2025, but its most recent filings also indicate the organization had a need to bolster its donations: It ended 2023 with a deficit of $661,379, after taking in $9.4 million in donations but spending $10.3 million. Miller appears to have still benefited handsomely from his involvement with America First Legal, however, reporting $508,659 in income from the group on his White House financial disclosure. Surprising Fact America First Legal lost to the Trump administration at the Supreme Court in the Kennedy v. Braidwood Management case. The administration took over the lawsuit and kept the Biden administration's position that the Preventive Services Task Force should stay in place. Further Reading Forbes Supreme Court Keeps Healthcare Coverage For Preventive Services—At Least For Now By Alison Durkee Forbes How Project 2025 Groups Influenced The Supreme Court This Year By Alison Durkee Forbes Supreme Court Upholds Ban On Gender-Affirming Care For Minors By Alison Durkee Forbes Supreme Court Lets Parents Opt Kids Out Of LGBTQ Books In Schools By Alison Durkee
Yahoo
29-06-2025
- Health
- Yahoo
US supreme court ruling sets stage for more politicized science under RFK Jr
A US supreme court decision affirming the constitutionality of Obamacare sets the stage for more politicized science in the future, health law experts said about the court's decision. The court's majority opinion in Kennedy v Braidwood Management found that an expert panel – the preventive services taskforce – convened under the Affordable Care Act is under the direct oversight of the health secretary. 'This is your classic good news, bad news,' said Lawrence Gostin, a professor of global health law at Georgetown Law. 'In a sane world, with a secretary of health that believes in science and doesn't bring in conspiracy theories and agendas, you would applaud this decision.' With health policy now in the hands of the Trump administration, 'it gives Secretary [Robert F Kennedy Jr] complete power about what to recommend and what not to recommend,' Gostin said. The court issued the opinion only hours after an expert vaccine advisory panel (ACIP) handpicked by Kennedy subverted the scientific consensus by recommending against vaccines containing thimerosal, a preservative overwhelmingly considered safe. Thimerosal has been a subject of misinformation and anti-vaccine advocacy for decades. Much like the expert panel in question in the Braidwood case, the recommendations of the vaccine advisory committee are a key link in the treatment distribution pipeline. Recommendations from both panels are typically affirmed by the leadership of the health department, and then become the basis on which insurers base coverage decisions. In the case of the ACIP, those recommendations typically concern vaccines. In the preventive taskforce context, they include a wide range of treatments – from statins to cancer screenings to HIV prevention. It was widely recognized that Kennedy had the authority to hire and fire people for the vaccine panel – but legal controversy existed about whether health secretaries have the same power over the preventive services taskforce. 'The president and the Senate are accountable 'for both the making of a bad appointment and the rejection of a good one',' wrote Justice Brett Kavanaugh for the six-vote majority. In other words, the court said, if you don't like it, go to the ballot box. MaryBeth Musumeci, an associate professor of health law management at the George Washington University Milken Institute of Public Health, told the Guardian: 'We have that structure in place – and that is a really great structure if the folks in charge are actually deferring to the experts and the science and what the evidence says.' She added: 'To the extent that we are going to make decisions based on bad science – that has really serious public health implications.' The panel at the center of the vaccine decision is the ACIP vaccine panel. Until June, the advisory panel was made up of 17 experts vetted by CDC career scientists. Their recommendations, while not binding, were almost always approved by CDC leadership. Kennedy fired all 17 members unilaterally in June and stocked the panel with eight ideological allies – including vaccine skeptics and medical professionals with little experience in vaccines. One panelist withdrew after a government financial review, and after it was widely publicized that the secretary's claims about the panelist's affiliation with two universities was false. Wayne Turner, a senior attorney for the National Health Law Program, which advocates for the medically underserved, said that he and others were 'certainly breathing a sigh of relief with the court's decision today' because a key provision of Obamacare was found to be constitutional. 'But that sigh of relief is really short-lived,' Turner said. 'We have long anticipated with the appointment of RFK Jr, and certainly with his actions with the ACIP, that we can fully expect the preventive services taskforce to be the next battleground in the ideological war this administration seems to be waging. And the war is against science.' The subject of the Braidwood case provides a salient example. Plaintiffs were suing the government to claim that the taskforce was wrongly appointed. Although their legal argument was thorny, one treatment they specifically cited as wrong was insurance coverage of pre-exposure prophylaxis (PrEP), an HIV prevention drug. Although the plaintiffs' claim that the taskforce was unconstitutional was swatted down, it provides activists with a roadmap to get what they want – if they can convince Kennedy to appoint more ideological allies to the taskforce. The preventive services taskforce may have one protective mechanism: a requirement that they be guided by evidence written into Obamacare, the legislation that impaneled them. Gearing up for another fight, Turner said: 'That's going to be an important thing for us to point to in the weeks and months ahead, and years, quite frankly.'
The Guardian
28-06-2025
- Health
- The Guardian
US supreme court ruling sets stage for more politicized science under RFK Jr
A US supreme court decision affirming the constitutionality of Obamacare sets the stage for more politicized science in the future, health law experts said about the court's decision. The court's majority opinion in Kennedy v Braidwood Management found that an expert panel – the preventive services taskforce – convened under the Affordable Care Act is under the direct oversight of the health secretary. 'This is your classic good news, bad news,' said Lawrence Gostin, a professor of global health law at Georgetown Law. 'In a sane world, with a secretary of health that believes in science and doesn't bring in conspiracy theories and agendas, you would applaud this decision.' With health policy now in the hands of the Trump administration, 'it gives Secretary [Robert F Kennedy Jr] complete power about what to recommend and what not to recommend,' Gostin said. The court issued the opinion only hours after an expert vaccine advisory panel (ACIP) handpicked by Kennedy subverted the scientific consensus by recommending against vaccines containing thimerosal, a preservative overwhelmingly considered safe. Thimerosal has been a subject of misinformation and anti-vaccine advocacy for decades. Much like the expert panel in question in the Braidwood case, the recommendations of the vaccine advisory committee are a key link in the treatment distribution pipeline. Recommendations from both panels are typically affirmed by the leadership of the health department, and then become the basis on which insurers base coverage decisions. In the case of the ACIP, those recommendations typically concern vaccines. In the preventive taskforce context, they include a wide range of treatments – from statins to cancer screenings to HIV prevention. It was widely recognized that Kennedy had the authority to hire and fire people for the vaccine panel – but legal controversy existed about whether health secretaries have the same power over the preventive services taskforce. 'The president and the Senate are accountable 'for both the making of a bad appointment and the rejection of a good one',' wrote Justice Brett Kavanaugh for the six-vote majority. In other words, the court said, if you don't like it, go to the ballot box. MaryBeth Musumeci, an associate professor of health law management at the George Washington University Milken Institute of Public Health, told the Guardian: 'We have that structure in place – and that is a really great structure if the folks in charge are actually deferring to the experts and the science and what the evidence says.' She added: 'To the extent that we are going to make decisions based on bad science – that has really serious public health implications.' The panel at the center of the vaccine decision is the ACIP vaccine panel. Until June, the advisory panel was made up of 17 experts vetted by CDC career scientists. Their recommendations, while not binding, were almost always approved by CDC leadership. Kennedy fired all 17 members unilaterally in June and stocked the panel with eight ideological allies – including vaccine skeptics and medical professionals with little experience in vaccines. One panelist withdrew after a government financial review, and after it was widely publicized that the secretary's claims about the panelist's affiliation with two universities was false. Wayne Turner, a senior attorney for the National Health Law Program, which advocates for the medically underserved, said that he and others were 'certainly breathing a sigh of relief with the court's decision today' because a key provision of Obamacare was found to be constitutional. 'But that sigh of relief is really short-lived,' Turner said. 'We have long anticipated with the appointment of RFK Jr, and certainly with his actions with the ACIP, that we can fully expect the preventive services taskforce to be the next battleground in the ideological war this administration seems to be waging. And the war is against science.' The subject of the Braidwood case provides a salient example. Plaintiffs were suing the government to claim that the taskforce was wrongly appointed. Although their legal argument was thorny, one treatment they specifically cited as wrong was insurance coverage of pre-exposure prophylaxis (PrEP), an HIV prevention drug. Although the plaintiffs' claim that the taskforce was unconstitutional was swatted down, it provides activists with a roadmap to get what they want – if they can convince Kennedy to appoint more ideological allies to the taskforce. The preventive services taskforce may have one protective mechanism: a requirement that they be guided by evidence written into Obamacare, the legislation that impaneled them. Gearing up for another fight, Turner said: 'That's going to be an important thing for us to point to in the weeks and months ahead, and years, quite frankly.'
Medscape
27-06-2025
- Health
- Medscape
Supreme Court Ruling Preserves Access to Preventive Services
Health advocates welcomed a US Supreme Court decision announced Friday that preserves a federal mandate for insurers to cover, without copays, certain preventive medical tests and treatments. The Supreme Court split 6-3 in the decision announced Friday. While the court ruling was seen largely as a win for medical and consumer groups, some voiced concerns about its impact on the Health and Human Services (HHS) Secretary's power over an influential panel, the US Preventive Services Task Force (USPSTF). Anthony Wright, executive director of the consumer advocacy group Families USA, said the Supreme Court ruling beat back 'yet another challenge' to the Affordable Care Act (ACA) and was a win in terms of guaranteeing more access to care. "While this is a foundational victory for patients, patients have reason to be concerned that the decision reaffirms the ability of the HHS secretary, including our current one, to control the membership and recommendations of the US Preventive Services Task Force that determines which preventive services are covered,' Wright said. Religious Objection to HIV Prevention Treatment The case stems from a complaint filed by Braidwood Management, a Christian-owned firm objecting to how a provision of the 2010 ACA has been implemented. The Texas firm wanted to exclude coverage of pre-exposure prophylaxis for HIV and other preventive health services for religious objections. The ACA requires coverage without copay for tests and treatments that get 'A' and 'B' ratings from the USPSTF. The USPSTF has issued recommendations with these top marks for more than 40 tests and treatments, noted Justice Brett Kavanaugh in the majority opinion in this case. Services with current 'A' and 'B' ratings from USPSTF include cancer and diabetes screenings, nicotine patches for adults trying to quit smoking, statin medications to reduce the risk of heart disease and stroke, and physical therapy to help the elderly avoid falls, he wrote. Major Medical Groups Applaud Ruling The American Medical Association, the American Academy of Family Physicians, the American Cancer Society, and about 30 other patient and medical professional organizations applauded the Supreme Court decision in a joint statement Friday. In February, these groups had filed a brief with the Supreme Court, arguing in favor of the mandate. In it, these groups said almost 152 million people in the US were able to get access to preventive services without cost sharing in 2020 due to the mandate. Reducing insurance coverage for preventive services would 'lead to worsening patient outcomes, resulting in preventable deaths, and creating higher long-term medical costs,' said the groups in the brief. The key question before the Supreme Court in this case focused on the view of authority of the USPSTF. In the majority opinion, Kavanaugh said the plaintiffs sought to portray the USPSTF as an independent agency wielding 'unchecked power in making preventive-services recommendations of great consequence for the healthcare and health-insurance industries and the American people more broadly.' In fact, those challenging the ACA mandate asserted that, with respect to preventive-services recommendations, the Task Force members were 'more powerful' than even the US president or the secretary of the HHS, Kavanaugh wrote. That's not the case, Kavanaugh wrote in the majority opinion. Instead, the USPSTF members serve at the will of the secretary of the HHS, who can remove them, Kavanaugh noted. In addition, federal law allows the HHS secretary to directly review and block USPSTF recommendations before they take effect, Kavanaugh wrote. Some Reservations Family USA's Wright noted how HHS Secretary Robert Kennedy Jr recently replaced members of the CDC's independent vaccine advisory committee as an example of his concerns. The American Gastroenterological Association called the Supreme Court ruling 'positive news for patient care protections.' 'The ruling reiterates the authority that HHS has over the task force and its decisions, and we remain vigilant considering the secretary's recent actions to other expert panels,' the AGA said Friday in a statement. 'We will continue to work with our coalition partners and champions to ensure patients continue to have coverage of essential preventive screenings.' The ACA mandate also has helped make cancer screening more palatable to younger patients, which physicians note is especially important given that more cases seem to be occurring earlier in life. National Institutes of Health researchers recently reported that the incidence of 14 cancer types increased among people under age 50 between 2010 and 2019. 'To convince healthy people to undergo a test when they're feeling fine to prevent a cancer that might or might not develop years in the future, it requires reducing barriers and taking away copays and providing insurance coverage,' Jatin Roper, MD, an assistant professor of medicine at Duke University and AGA spokesman, told Medscape in recent interview. Roper reported no relevant financial disclosures.
