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Supreme Court Upholds Coverage under the Affordable Care Act

Client Alert

On June 27, 2025, the U.S. Supreme Court issued a landmark decision upholding the authority of the U.S. Preventive Services Task Force (USPSTF) to make determinations about preventive services coverage mandated by the Affordable Care Act (ACA). The ACA mandates that group health plans and health insurance issuers provide coverage for over 100 preventive health services without cost-sharing.

Following the Supreme Court’s ruling, the USPSTF can continue issuing recommendations for services that must be covered by health insurers without cost-sharing.

In Kennedy v. Braidwood Mgmt. Inc., No. 24–316. (S.C. 2025), Braidwood Management (and others) argued that the USPSTF’s requirement to cover an HIV prevention medication violated its religious freedoms.

In its ruling, the Supreme Court reversed a Fifth Circuit decision that had found the delegation of authority to the USPSTF violated the Appointments Clause. The Supreme Court reasoned that USPSTF members are “inferior officers” of the Department of Health and Human Services (HHS) Secretary instead of “principal officers”, despite their independence in the Affordable Care Act context.

As a result, the USPSTF can continue to recommend coverage for preventive services using a grading system. Per the ACA, for covered services with an 'A' or 'B' rating, health plans and insurance issuers offering group or individual insurance coverage “shall, at a minimum, provide coverage for and not impose any cost sharing requirements” for the “evidence-based items or services that have in effect a rating of ‘A’ or ‘B’ in the current recommendations” of the USPSTF. Covered services with an 'A' or 'B' rating include certain cancer screenings, risk-reducing breast cancer medications, statin medications reducing the risk of heart disease and stroke, and physical therapy to help the elderly avoid falls.

The practical coverage provisions of the ACA remain in effect, meaning over 150 million Americans can continue to access a wide range of preventive health care services each year at no cost to them. For providers, this ruling maintains the status quo, ensuring providers can continue to provide screenings and resulting treatment paid for by insurance without having to chase patients for cost sharing amounts.  

The case is Kennedy v. Braidwood Mgmt. Inc., No. 24–316. (S.C. 2025).

To learn more about this ruling and the ACA’s coverage of preventive services, please contact BMD Healthcare Member Daphne Kackloudis at dlkackloudis@bmdllc.com or Attorney Jordan Burdick at jaburdick@bmdllc.com.


DEA and HHS Issue its Third Extension of Telemedicine Flexibilities through 2025

The DEA and U.S. Department of Health and Human Services (HHS) have extended telemedicine flexibilities for prescribing controlled medications through December 31, 2025. This extension builds on temporary exceptions made in 2020 due to COVID-19, allowing providers to prescribe Schedule II-V controlled substances based on a telemedicine evaluation alone. The extension ensures continued patient access to necessary prescriptions and provides time for providers to comply with future regulations.

Medicare Making Changes to Improve Behavioral Health Care Access

The Centers for Medicare & Medicaid Services (CMS) has introduced changes to Medicare’s behavioral health coverage, including allowing Marriage and Family Therapists and Mental Health Counselors to enroll independently, increasing reimbursements for crisis psychotherapy and substance use treatment, and expanding services via community health workers. These updates address gaps in care and improve access to mental health services for Medicare beneficiaries.

The Ohio Department of Medicaid Announces Four Next Generation MyCare Plans

On November 1, 2024, the Ohio Department of Medicaid (ODM) announced four managed care organizations that will become ODM’s Next Generation MyCare plans starting January 2026. MyCare Ohio is a managed care program that supports Ohioans across 29 counties enrolled in both Medicare and Medicaid.

Corporate Transparency Act Reporting Deadline: December 31

The Corporate Transparency Act (“CTA”), which became effective January 1, 2024, imposes strict reporting guidelines on small business owners throughout the country.  The deadline for non-exempt businesses to submit reporting is December 31, 2024.

Permanent Injunction of “Heartbeat” Abortion Ban in Ohio

Hamilton County Common Pleas Judge Christian Jenkins has ruled Ohio’s six-week abortion ban unconstitutional, citing the state’s new reproductive rights amendment. This ruling emphasizes that Ohio law must fully reflect the will of voters, offering clarity for medical providers and safeguarding women's health care rights.