Biden administration urges Supreme Court to uphold ACA mandate requiring cost-free cancer screenings

The Biden administration is urging the Supreme Court to overturn a lower court’s decision creating uncertainty around the Affordable Care Act mandate that insurers cover cancer screenings and other preventive services. 

The Fifth Circuit Court of Appeals previously announced its ruling in Braidwood vs. Becerra in June. Experts noted at the time that the “mixed bag” decision threw the ACA mandate into question, potentially eliminating coverage of such care for hundreds of millions of Americans.

Attorneys with the Justice Department filed a petition Sept. 19, urging Supreme Court justices to take up the matter. 

“The court’s holding jeopardizes healthcare protections that have been in place for 14 years and that millions of Americans currently enjoy,” the DOJ said in the filing.

In place since 2010, the ACA provision has required insurers to provide no-cost coverage for screening services such as mammography that are endorsed by the U.S. Preventive Services Task Force. Christian business owners and individuals filed the lawsuit in 2020, claiming the ACA requirement violates their religious rights by forcing them to cover preventive drugs for HIV. Plaintiffs also have contended that members of the U.S. Preventive Services Task Force and other such entities act as officers of the country but were not properly selected in accordance with the Constitution’s Appointments Clause. 

The court of appeals on June 21 affirmed a district court’s decision that the requirement is unconstitutional. However, it also ruled that a nationwide remedy was not proper, and that only the plaintiffs were permitted to exclude USPSTF-recommended services from their health plans, the Kaiser Family Foundation noted. Meanwhile, the Biden administration is arguing that Health and Human Services does, in fact, supervise the task force, making the rule valid. Attorneys also are urging that, if the Supreme Court disagrees, then justices should remedy this constitutional flaw, as they have in previous cases. 

A year ago, the sides had reached an agreement to keep the mandate in place while the case plays out, the American College of Radiology reported. ACR had noted that the case applies to all USPSTF recommendations issued on or after March 23, 2010, which was the day President Obama signed the ACA into law. This would include the task force’s December 2013 endorsement of regular lung cancer screening, with CT-based imaging of the colon likely also impacted.

Amid confusion around the ruling, ACR reported that some commercial insurers were requiring patient cost-sharing for USPSTF-endorsed services. Leaders have urged members of the specialty to contact the college, if they experience any prior authorization or other roadblocks related to lung, breast and colon cancer screening.

“If the link between the ACA and USPSTF recommendations is dropped, the judge’s ruling will have major public health ramifications across a broad range of preventative services,” ACR said last year. “If not overturned by appeal, this decision will have a significant negative impact on patients’ access to lifesaving cancer screening services.”

For more on the case, you can read this JAMA Network viewpoint published Monday and recent coverage from Law Dork and Inside Health Policy (subscription required for the latter).