What services are most at risk in the Supreme Court case challenging the ACA preventive care rule?

By Anu Dairkee, Clinical Fellow, and Elizabeth Kaplan, Director of Health Care Access

Under the preventive care rule of the Affordable Care Act (ACA) services with a grade A or B recommendation from the U.S. Preventive Services Task Force (USPSTF), services for women and children recommended by the Health Resources and Services Administration (HRSA), and vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) are required to be covered free of cost for individuals whose health care is insured by non-grandfathered private insurance plans. The preventive care rule is one of the most popular sections of the ACA, it has received bipartisan support, and it helps to ensure that cost is not a factor when people decide to get or are prescribed preventive care. But a case that has been weaving its way through the U.S. justice system, Braidwood v. Becerra—which the Supreme Court plans to hear in 2025—is threatening the preventive care rule especially as it applies to the USPSTF. In a new chart, CHLPI compiles and analyzes the recommendations most at risk in this litigation.

Thus far, in both the U.S. District Court for the Northern District of Texas and the U.S. Court of Appeals for the Fifth Circuit, judges have held that members of the USPSTF were not constitutionally appointed under the Appointments clause of the U.S. Constitution. Hence, requiring coverage of preventive services that they recommend under the preventive care rule is unconstitutional. These rulings threaten access to cost-free coverage of preventive care as recommended by the USPSTF. On Friday, January 10, 2025, the Supreme Court agreed to hear the federal government’s challenge to the Fifth Circuit’s ruling.

While the litigation threatens coverage of services recommended by all three agencies—the USPSTF, ACIP, and HRSA—the USPSTF’s recommendations are at greatest risk. This is because, according to the District Court and the Fifth Circuit, the USPSTF is not subject to sufficient control by a constitutionally appointed executive branch officer such as the Secretary of the Department of Health and Human Services. In comparison, ACIP’s and HRSA’s recommendations have been ratified by the Secretary, although litigation is ongoing over the validity of those ratifications.

There are 54 A and B recommendations issued by the USPSTF currently in force, which impact a broad range of conditions within the medical fields of pediatrics, infectious diseases, oncology, psychiatry, cardiology, and more. Of these recommendations, those most likely to be impacted by Braidwood are those newly published or updated since March 23, 2010, the day the ACA was enacted. Although the Supreme Court’s ruling could undermine guaranteed access to coverage of all USPSTF-recommended services, those that predate March 23, 2010, may be insulated from such a ruling because Congress presumably was aware of them and incorporated them by reference into the ACA upon enactment.

CHLPI has therefore created a chart analyzing all USPSTF A and B recommendations published as of January 2025  to show how current USPSTF A and B recommendations differ from their March 2010 versions (if versions of them existed at the time). Many of the current USPSTF A and B recommendations have undergone significant changes since 2010 that either expand the target population, recommend a better testing modality, or consider the disparate impact of preventive care for certain conditions among select populations. Since recommendations by USPSTF, ACIP, and HRSA sometimes overlap, the chart also analyzes whether there are recommendations made by either ACIP or HRSA that would at least partially ensure coverage for services included under an at-risk USPSTF recommendation. In some cases, there is adequate coverage from ACIP and HRSA, but most of the time there is not.

The breadth of services discussed in the chart, and the extent of updates since 2010 as the USPSTF has considered new medical evidence regarding the benefits and harms of specific preventive services, underscore the urgent need to ensure ongoing free access to these services. CHLPI will continue to analyze this case and its potential impacts as the fight to preserve free preventive care access marches on.

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