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SUPREME COURT TO HEAR CHALLENGE TO FREE ACA PREVENTIVE CARE

This article, written by Berkely Lovelace Jr., appeared in the NBC News Health News  on April 18.

The Supreme Court heard arguments on April 21 in a case challenging a provision of the Affordable Care Act that requires private insurers to cover health care screening, tests, and checkups for free.

Experts say the court’s ruling in the case (Kennedy v. Braidwood Management) could have sweeping consequences for patient access to preventive health care across the United States.

Since the ACA was passed in 2010, most insurers have had to cover a wide range of preventive services at no cost to patients — including cancer screenings, mammograms, statins for heart disease and HIV preventive medications.

About 150 million people are currently enrolled in private health insurance plans that cover free preventive services, according to KFF, a nonpartisan group that researches health policy issues. A KFF analysis found that 1 in 20 people — about ten million people — received at least one preventive service in 2019.

“This is a really crucial case,” said Arthur Caplan, the head of the division of medical ethics at NYU Langone Medical Center in New York City, noting that many Americans say they can’t afford the high out-of-pocket cost of medical care. “The price will be paid in dead bodies if the court rules against.”

The lawsuit was filed in 2022 by a group of conservative Christian employers in Texas.

They argued that the ACA rule requiring them to cover the HIV prevention pill PrEP in their employee health plans violated their religious rights. 

They also challenged the U.S. Preventive Services Task Force — an independent panel that recommends which preventive services insurers must cover — calling it unconstitutional because its members aren’t appointed by the President or confirmed by Congress.

Last year, the 5th U.S. Circuit Court of Appeals sided with the employers, but limited the decision to just the eight Texas companies involved in the case. The court declined to make the ruling apply nationwide.

Under the Biden administration, the federal government appealed the case to the Supreme Court. The Trump administration then told the court in February that it intended to defend the requirement.

What happens if the Supreme Court strikes down the ACA rule?

The Supreme Court is expected to make a decision sometime in June.  

If the court strikes down the ACA rule, it would mean insurers could deny coverage for preventive services recommended by the task force, said Laurie Sobel, an associate director for women’s health policy at KFF.

“The recommendations would go back to March 2010,” Sobel said, referring to the year the ACA was enacted. Notable changes, she added, could include the starting age that most insurers cover colorectal cancer screens as well as coverage of PrEP. The current recommended age for colon cancer screening is forty-five, which the task force lowered from age 50 in 2021 and is credited with saving thousands of lives.

If the free preventive services requirement goes away, Richard Hughes, a health care attorney for Epstein Becker & Green and lead counsel for the HIV+Hepatitis Policy Institute, said coverage could vary by insurance company.

“I think you’ll see some gradual erosion across the board,” Hughes said, referring to the services that insurers cover. “I think you’re going to see some restriction of access, you’re going to see cost sharing applied to certain services, and that’s been shown to be a barrier, because people are more inclined to walk away from a service when they’re presented with an out-of-pocket cost.”

It’ll also be harder to get people into the doctor’s office to seek preventive care, Sobel said. “Right now we can say, if you’re on a private health insurance plan … then you’re entitled to no cost sharing,” she said.

Even if the Supreme Court sides with the Trump administration, Sobel said, there are concerns about what Health Secretary Robert F. Kennedy Jr. could do to the task force.

In a court filing, the Trump administration said task force members “are inferior officers, because the Secretary of HHS — a quintessential principal officer — remains responsible for final decisions about whether Task Force recommendations will be legally binding on insurance issuers and group health plans.”

“Even a ruling in favor of the federal government doesn’t necessarily assure that the preventative services will remain how they are right now,” Sobel said.

Chronic conditions such as heart disease, cancer and diabetes are the leading causes of death and illness in the United States, according to the Centers for Disease Control and Prevention. A 2024 report from the Center for American Progress found the ACA rule has been linked to more Americans with better blood pressure, blood sugar levels and overall heart health. Other studies suggest it increased early-stage cancer diagnosis.

Caplan said he hopes Kennedy himself weighs in on the case.

“It doesn’t make any sense to keep talking about Make America Healthy Again while taking away preventive services,” he said.

HOW MUCH MORE WOULD PEOPLE PAY IN PREMIUMS IF THE ACA’S ENHANCED SUBSIDIES EXPIRED?

The Kaiser Family Foundation has provided the following article and information.

Enhanced Affordable Care Act (ACA) subsidies lower premium payments for ACA Marketplace coverage by boosting existing ACA subsidies and making some people newly eligible. Enrollees across incomes benefit from these subsidies. For example, low-income enrollees (making up to 150% of the poverty level) became eligible for free or nearly free coverage. Those earning over four times the federal poverty level ($124,800 for a family of four), previously ineligible for subsidies, saw their premium payments newly capped at 8.5% of income, eliminating the “subsidy cliff.” Enhanced subsidies have reduced premium payments by an estimated $705 a year for enrollees receiving premium tax credits.

First enacted in 2021 under the American Rescue Plan Act, the enhanced subsidies were renewed through the end of 2025 by the Inflation Reduction Act. Since their implementation, ACA Marketplace enrollment has grown each year and hit record highs, reaching over twenty-one million in 2024. Southern states have seen the most growth in ACA Marketplace signups.

If these enhanced subsidies are not renewed by Congress and expire at the end of 2025, ACA enrollee premium payments are expected to increase by over 75% on average, with people in some states seeing their payments more than double. Without further extension, the Congressional Budget Office (CBO) estimates ACA enrollment will drop from 22.8 million in 2025 to 18.9 million in 2026 and fall to 15.4 million in 2030. While some may be able to find other sources of coverage, others will become uninsured.

EXPLAINING HEALTH CARE REFORM: QUESTIONS ABOUT HEALTH INSURANCE SUBSIDIES

The following brief from the Kaiser Family Foundation provides an overview of the financial assistance currently provided under the Affordable Care Act for people purchasing cover on their own through health insurance Marketplaces (also called exchanges.)

The brief contains a calculator that illustrates how the expiration of enhanced subsidies December 31, 2025 might affect 2026 subsidy payments, thus offering a preview of potential changes.  If you're receiving a subsidy and want to know how you might be affected by failure to extend the subsidy improvements contained in the Inflation Reduction Act, you should open the brief, enter your information, and you'll receive an estimate of how you might be affected.

PROPOSED CHANGES TO AFFORDABLE CARE ACT PLANS FOR 2026

The Centers for Medicare and Medicaid Services (CMS) has released the 2025 Marketplace Integrity and Affordability Proposed Rule, outlining important changes that could significantly impact enrollment processes, consumer eligibility, and agent compliance requirements.

Proposed Changes to Enrollment Processes And Consumer Eligibility:

Special Enrollment Periods (SEPs)

• The monthly SEP for individuals under 150% of the Federal Poverty Level (FPL) is proposed for removal.
• SEP eligibility verification will be required for all income levels across all Exchanges by 2026.

Open Enrollment Period (OEP)

• OEP would be shortened to run from November 1 through December 15, starting with Plan Year 2026. (The Open Enrollment period currently runs from November 1 through January 15.)

Premium Payments



• Issuers may be allowed to require payment of past-due premiums before activating new coverage.
• Proposed changes would eliminate certain premium payment thresholds.

Automatic Re-enrollment

• Consumers who are automatically re-enrolled without updated advance payment tax credit (subsidy) information may be required to pay a minimum $5 monthly premium until eligibility is verified.
• Proposed changes also impact how Cost Sharing Reduction (CSR) enrollees are re-enrolled.

Income and Eligibility Verification

• Increased scrutiny and requirements for income verification.
• Exchanges could disqualify individuals for subsidies after just one year (currently two years) of failure to file and reconcile taxes.

About Paul Cholak

Paul has over forty years of benefits experience and has been Director of Employee Benefits for large companies, as well as a benefits consultant with major consulting firms. He understands the health and life insurance needs of individuals and families of all ages. He also has considerable experience in selling health and life insurance to employer groups.

He guides you through the steps of getting health and/or life insurance and is available to help you both BEFORE and AFTER you've made your purchase decision.