{"id":34367,"date":"2025-04-24T10:43:47","date_gmt":"2025-04-24T14:43:47","guid":{"rendered":"https:\/\/advisory.avalerehealth.com\/?p=34367"},"modified":"2025-04-24T11:21:54","modified_gmt":"2025-04-24T15:21:54","slug":"uspstf-at-a-crossroads-preventive-care-coverage-mandate-at-scotus","status":"publish","type":"post","link":"https:\/\/advisory.avalerehealth.com\/insights\/uspstf-at-a-crossroads-preventive-care-coverage-mandate-at-scotus","title":{"rendered":"USPSTF at a Crossroads: Preventive Care Coverage Mandate at SCOTUS"},"content":{"rendered":"

Background on USPSTF<\/strong><\/p>\n

The US Preventive Service Task Force (USPSTF) is an independent panel of 16 experts appointed by the Secretary of Health and Human Services (HHS) that voluntarily provide recommendations on preventive services for adults and children provided in the primary care setting. USPSTF evaluates specific interventions and issues recommendation with a letter grade (A, B, C, D, or Insufficient [I] statement) based on the strength of existing evidence and the net benefits of a preventive service. Under the Affordable Care Act (ACA), services received a USPSTF Grade A or Grade B must be covered by Medicare and third-party insurance carriers without member cost sharing.<\/p>\n

Legal Challenges to Preventive Services Coverage Mandate<\/strong><\/p>\n

In September 2022, the US District Court for the Northern District of Texas issued a\u00a0ruling\u00a0<\/a>in\u00a0Braidwood Management Inc. vs.\u00a0Becerra, <\/em>a case which challenged the legality of the ACA\u2019s preventive services<\/a> coverage mandate under the US Constitution and the Religious Freedom Restoration Act. The court ruled that health plans are not required to cover services recommended by the USPSTF because its panel members are not properly appointed under the Constitution\u2019s Appointments Clause. Following the decision, the Biden administration appealed the court\u2019s ruling to the US Court of Appeals for the Fifth Circuit,<\/p>\n

In June 2024, the court of appeals issued a\u00a0decision<\/a>\u00a0reversing the lower court\u2019s decision to vacate all agency actions to enforce preventive care coverage mandates. However, this ruling agreed with the lower court\u2019s ruling that the USPSTF panel had not been validly appointed under the Appointments Clause.<\/p>\n

Supreme Court Considers Preventive Services Coverage<\/strong><\/p>\n

The case was appealed to the Supreme Court and on April 21, 2025, justices heard oral arguments in Kennedy vs. Braidwood Management Inc<\/a><\/em>. Their decision, which is expected in June, could affect access to non-cost share preventive health services under the ACA.<\/p>\n

According to reporting by Roll Call<\/em><\/a>, the tenor of justices\u2019 questions indicate support for upholding the preventive coverage mandate and dismissing the Fifth Circuit\u2019s decision. Of note, there were several justices who \u201cquestioned the reasoning behind a decision by the US Court of Appeals for the 5th Circuit, which held that the Task Force that makes decisions about preventive care was unconstitutional because the Senate does not confirm its members.\u201d The Trump administration stated that HHS currently has the ability to overturn any recommendations and remove Task Force members, both of which will have implications for the future work of the USPSTF as well as for public health.<\/p>\n

Next Steps<\/strong><\/p>\n

Avalere Health\u2019s cross functional team is uniquely capable of supporting stakeholders interested in successfully navigating the evolving landscape of USPSTF recommendations and submission processes<\/a>. Understanding the access landscape for screening requires a partner with strategic foresight and deep expertise in evidence, policy, and quality frameworks. Leveraging expertise in evidence generation and planning, market strategy, and policy shaping, Avalere Health can provide strategic recommendations that meet individual client needs. To learn more about how Avalere Health can assist you connect with us.<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Background on USPSTF The US Preventive Service Task Force (USPSTF) is an independent panel of 16 experts appointed by the Secretary of Health and Human Services (HHS) that voluntarily provide recommendations on preventive services for adults and children provided in the primary care setting. USPSTF evaluates specific interventions and issues recommendation with a letter grade…<\/p>\n","protected":false},"author":28,"featured_media":27977,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[3],"tags":[],"content-categories":[1023],"class_list":["post-34367","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-insights","content-categories-coverage-and-payment","entry","has-media"],"acf":[],"yoast_head":"\nUSPSTF at a Crossroads: Preventive Care Coverage Mandate at SCOTUS | Avalere Health Advisory<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/advisory.avalerehealth.com\/insights\/uspstf-at-a-crossroads-preventive-care-coverage-mandate-at-scotus\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"USPSTF at a Crossroads: Preventive Care Coverage Mandate at SCOTUS | Avalere Health Advisory\" \/>\n<meta property=\"og:description\" content=\"Background on USPSTF The US Preventive Service Task Force (USPSTF) is an independent panel of 16 experts appointed by the Secretary of Health and Human Services (HHS) that voluntarily provide recommendations on preventive services for adults and children provided in the primary care setting. 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