The Supreme Court is deliberating a case that could impact an untold number of Americans. What hangs in the balance, public health experts warn, are a range of critical services and treatments — from breast cancer screenings to statins — that are currently covered by insurance as mandated by the Affordable Care Act, but that could all change.
“We’ve made a lot of progress in getting breast cancers detected earlier and improving outcomes,” Molly Guthrie, the VP of policy and advocacy at Susan G. Komen, tells us. “There’s significant concern that this will undo that progress.”
Here’s a breakdown of this hugely consequential and complex case and the direct effect it could have on you.
The Supreme Court ACA Challenge
In Kennedy v. Braidwood Management, Christian-owned businesses and six individuals in Texas are challenging the ACA’s requirement to cover preventive services. Their initial objection centered on covering a popular medication that prevents HIV called pre-exposure prophylaxis treatment (PrEP), claiming it’s a violation of their religious freedom.
In 2022, a district court sided with them. But it also took aim at the U.S. Preventive Services Task Force (USPSTF), an independent panel of experts who develop the guidelines for cancer screenings and other recommendations, which nearly all private insurers and Medicaid must cover without cost sharing. The court’s ruling deemed that panel unconstitutional, because members of the task force are neither appointed by the president nor confirmed by Congress.
The Biden administration appealed, and the Supreme Court agreed to take up the case just days before President Trump’s second inauguration. And although our current president has notably not been a fan of the ACA, his administration has opted to continue the case — although some experts suspect that their real reason for doing so is to empower the administration to veto certain task force recommendations, STAT reports.
How could Kennedy v. Braidwood affect cancer screenings and other services?
Although this case started out as a fight over PrEP, a range of other crucial treatments and services have found themselves in the crosshairs.
One of the major responsibilities of the USPSTF is to issue guidance over when and how regularly people should be screened for certain cancers. That means all types of tests — from mammograms for breast cancer to colonoscopies for colorectal cancer to CT scans for lung cancer — are covered by insurance with no out-of-pocket cost. But it’s not only scans that are covered: risk-modifying medications like tamoxifen or certain aromatase inhibitors qualify, as does genetic counseling and testing for the BRCA gene, Guthrie says.
The net benefit of that is “hard to quantify,” according to Lynn Goldman, dean of the Milken Institute School of Public Health at George Washington University — but she tells us it’s almost certainly saved lives.
“We know that when people have to pay out of pocket for services, that depresses the use of it,” she says. If this ACA provision were struck down, there’s a real fear among public health experts that far fewer people will get screened, and cancers will be detected later, when they’re far harder to treat.
Beyond cancer, there’s a long list of other services at risk, like statins, a widely used drug for cardiovascular disease, testing and vaccinations for sexually transmitted infections, and screening for diabetes. It’s a long list that touches millions of Americans. That’s why Susan G. Komen, the American Cancer Society, and other influential non-profits have submitted briefs urging the court not to overturn the ACA provision.
“It could really upend a lot of the progress we’ve seen and a lot of the good these services provide,” Guthrie says.
How is the Supreme Court expected to rule?
During opening arguments this week, some legal observers noted that a majority of the justices seem to be leaning toward keeping the ACA intact.
All three of the court’s Democrats appeared likely to uphold the authority of the task force, Vox reports, as do two of its conservative jurists. Amy Coney Barrett and Brett Kavanaugh both seemed skeptical in their questioning of the plaintiffs, who are represented by Jonathan Mitchell — a former attorney for Donald Trump.
However, the court may also decide to send the case back down to the lower court, as Justice Neil Gorsuch suggested. In any case, a decision is expected this June or July, Guthrie tells us.
