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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.


New Medicare Billing Rules: What MFTs, MHCs, and IOP Providers Need to Know

Starting January 1, 2024, Medicare began covering services provided to Medicare beneficiaries by marriage and family therapists, mental health counselors, and Intensive Outpatient Program (IOP) services. With this change, Medicare has become the primary payer for these services.

Chevron Doctrine No More: What the Supreme Court’s Ruling Means for Agency Authority

On June 28, 2024, the Supreme Court invalidated the Chevron doctrine, nearly 40 years after it first took effect.

Ohio Board of Pharmacy Update: Key Regulatory Changes and Proposals You Need to Know

The Ohio Board of Pharmacy (BOP) has rescinded certain OAC rules (OAC 4729:5-18-01 through 4729:5-18-06), removing regulations on office-based opioid treatment (OBOT) clinics. The rescissions took effect on June 3, 2024. The BOP also published a new rule, OAC 4729:8-5-01, which sets explicit reporting guidelines for licensed dispensaries and became effective on June 7, 2024.

LGBTQIA+ Patients and Discrimination in Healthcare

In early April, the Kaiser Family Foundation released a study outlining the challenges that LGBT adults face in the United States related to healthcare. According to the study, LGBT patients are “twice as likely as non-LGBT adults to report negative experiences while receiving health care in the last three years, including being treated unfairly or with disrespect (33% v. 15%) or having at least one of several other negative experiences with a provider (61% v. 31%), including a provider assuming something about them without asking, suggesting they were personally to blame for a health problem, ignoring a direct request or question, or refusing to prescribe needed pain medication.”

Ohio Recovery Housing Overhaul: New Standards and Certification Requirements Reshape Sober Living Spaces