The U.S. Supreme Court will soon decide if women across the country will continue to receive no-cost mammograms. The decision could come as soon as June.
In addition to mammogram coverage, the High Court is also deciding whether insurance companies will be required to cover vital care needed to detect and lower one’s risk of developing breast cancer.
The Affordable Care Act (ACA) requires insurers to cover the full cost of services receiving an A or B grade by the U.S. Preventive Services Task Force (USPSTF) including screening mammograms ; risk-modifying medications such as tamoxifen, raloxifene, or certain aromatase inhibitors for women at higher than average risk of developing breast cancer; and genetic counseling and testing for some individuals who have a personal or family history of breast, ovarian, tubal, or peritoneal cancer, or an ancestry associated with breast cancer susceptibility.
In the Braidwood Management, Inc. et al v. Robert Kennedy Jr. et al. court case, plaintiffs argue the no-cost preventive services requirement is unconstitutional because it violates the Appointments Clause as USPSTF members are not confirmed by the U.S. Senate. The USPSTF requires insurance companies to cover many services that seek to prevent many types of cancer – in addition to breast health services, pap smears, colonoscopies, smoking cessation programs and prostate cancer screenings are also covered.
More than 150 million Americans rely on preventive care services that are in jeopardy because of the rulings in lower courts.
“It is undeniable that the preventive care covered by the ACA has made a meaningful difference in the lives of people throughout the country. Moreover, early detection can reduce the risk of being diagnosed with advanced cancer,” Komen wrote in an Amicus Brief filed with the Supreme Court.
So far, a District Court in Texas has ruled in favor of the plaintiffs. That ruling was appealed to the Fifth Circuit Court of Appeals, and the Appeals Court agreed with the District Court ruling. It, however, narrowed the scope of the law and said it will only apply to the parties who filed the lawsuit.
“By striking the requirement that insurers cover certain preventive care measures, the district court’s judgment ensures that fewer people will have access to these preventive care measures. That outcome will be devastating,” Komen continued.
The District Court’s decision has been appealed to the Supreme Court, and oral arguments are expected to be heard in April.
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Braidwood Lawsuit Timeline
Mar 29, 2020 – Plaintiff files complaint in Texas Northern District Court challenging the Affordable Care Act’s preventive services requirement as unconstitutional because it violates the Appointments Clause, the nondelegation doctrine, and the Religious Freedom Restoration Act in a case known as Braidwood Management Inc. v. Becerra.
September 7, 2022 – The District Court, Judge O’Connor, holds that (1) the requirement for most commercial plans to cover preventive services without cost sharing violates the Appointments Clause and is thus unconstitutional; (2) the requirement that insurers and plans cover an HIV prevention medication violates plaintiff’s rights under the Religious Freedom Restoration Act (RFRA); and (3) rejects the plaintiffs’ arguments regarding the Vesting Clause and the nondelegation doctrine. Additionally, Judge O’Connor asks the parties for more information on the scope of relief, the appropriate remedy, and outstanding claims on the contraceptive mandate.
March 30, 2023 – Judge O’Connor issues order that setting aside all USPSTF’s recommendations issued after March 2010 and puts in place a universal, nationwide injunction prohibiting the government from enforcing the cost-free coverage requirement on insurance plans.
April 3, 2023 – The government appeals the District Court decision to the Fifth Circuit Court of Appeals.
May 15, 2023 – The Fifth Circuit stays Judge O’Connor’s remedy allowing the cost-free coverage requirement to remain in effect while the case proceeds.
Jun 27, 2023 – Susan G. Komen files Amicus Brief in support of coverage of preventive services, such as mammography, without cost sharing.
June 21, 2024 – The Fifth Circuit Court of Appeals upholds the District Count decision and concludes that the operation and lack of oversight for the USPSTF violated the Constitution’s Appointments Clause. However, the Fifth Circuit finds that the District Court erred in granting the plaintiffs nationwide and limited relief to only the named plaintiffs.
September 19, 2024 – The government files a petition of a writ of certiorari requesting that the Supreme Court of the Unites States (SCOTUS) review the judgment of the Fifth Circuit Court of Appeals.
January 10, 2025 – SCOTUS grants certiorari, agreeing to review the case.
February 25, 2025 – Susan G. Komen Files an updated Amicus Brief in support of coverage of preventive services, such as mammography, without cost sharing.
April 21, 2024 – Oral arguments scheduled before SCOTUS for Kennedy v. Braidwood Management Inc.
