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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.


Ensuring Fair Access: SB 269 Protects Affordable Medication for Low-Income Patients

SB 269, introduced on December 19, 2023, will ensure that 340B covered entities, including Federally Qualified Health Centers, Ryan White Clinics, disproportionate share hospitals, and Title X clinics, can acquire 340B drugs without facing undue restrictions or discriminatory practices from drug manufacturers and distributors. This protection is crucial for 340B covered entities to continue to provide affordable medications and comprehensive services to low-income patients.

Unveiling Ohio's Pharmacy Board Updates for Distributors, Mobile Clinics, and Controlled Substances

The Ohio Board of Pharmacy will hold a public hearing on May 28, 2024, to discuss several proposed changes and additions to Ohio Administrative Code (OAC). These changes pertain to terminal distributors of dangerous drugs (TDDDs), mobile clinics or medication units, and the classification of controlled substances.

House Bill 249: Key Updates to Involuntary Hospitalization Law for Mental Health Providers

House Bill 249 (HB 249) proposes changes to Ohio Revised Code (ORC) Sections 5122.01 and 5122.10 to expand the conditions under which a person with a mental illness can be involuntarily hospitalized.

Starting an Advanced Practice Provider Practice

Advanced practice providers (APPs), which includes non-physician providers such as nurse practitioners, physician assistants, and nurse anesthetists, commonly start their own healthcare practices. Practices may provide, for example, service offerings such as primary care, anesthesiology, mental health, and aesthetics (medical spas). However, there are a number of considerations and steps that must be taken for APPs to compliantly function independently.

FTC Increases Targeting of Companies Lacking Cyber Protection

The Federal Trade Commission (FTC) recently released a comprehensive cybersecurity report outlining key findings and recommendations based on emerging threats, trends in data breaches, and strategies for businesses to enhance their cybersecurity posture observed over the last year.