Summary
Two recent U.S. Supreme Court rulings support provisions of the Affordable Care Act, one directly and one indirectly.
The Upshot
- In a year-end decision, the Court affirmed the authority of the United States Preventive Services Task Force (USPSTF) to issue recommendations that require health plans to cover the full cost of certain preventive health services and products.
- In a case unrelated to health benefits, the Court ruled that federal district courts lack the authority to issue universal injunctions that apply beyond the parties to the actual litigation.
The Bottom Line
Plans will need to continue to provide 100 percent coverage for preventive health services with an A or B recommendation from the USPSTF. Based on the Court’s ruling, federal district courts will no longer be allowed to issue injunctions against enforcement of the Affordable Care Act that apply on a nationwide basis.
Supreme Court Injunction Rulings Support Affordable Care Act
The U.S. Supreme Court issued two year-end decisions that provide support for provisions of the Affordable Care Act and other federal health legislation.
Kennedy v. Braidwood Management, Inc.
In Kennedy v. Braidwood Management, Inc., the Supreme Court upheld the authority of the United States Preventive Services Task Force (USPSTF) to issue guidance that requires health plans to cover certain preventive care services at 100 percent. As a result, health plans will continue to be required to provide health coverage without any cost to plan participants for services and products that receive an A or B recommendation from the USPSTF.
Plaintiffs had challenged the authority of the USPSTF to make recommendations having this effect under the Affordable Care Act. They argued that giving the USPSTF this power violated the Appointments Clause of the U.S. Constitution because its members were principal officers who needed to be, but were not, nominated by the President and confirmed by the U.S. Senate. The federal district court agreed and issued a universal injunction, which applied nationwide. The Fifth Circuit Court of Appeals upheld the injunction but narrowed its effect to the plaintiffs in the case. The Supreme Court reversed the determination that the appointment violated the Appointments Clause, finding that the U.S. Secretary of Health and Human Services exercised sufficient control over the USPSTF to render them inferior officers, who did not need to go through the nomination and confirmation process.
Importantly, the Braidwood decision does not curtail defenses available under the Religious Freedom Restoration Act of 1993 (RFRA). The Fifth Circuit granted the Plaintiff’s request for an injunction based on RFRA. This issue was not on appeal to the Supreme Court.
Trump v. Casa, Inc.
In a separate decision, the Supreme Court addressed one of the key holdings in the Fifth Circuit’s decision in Braidwood: namely, whether courts are permitted to issue injunctive relief on a nationwide basis. In Trump v. Casa, Inc., the U.S. Supreme Court determined that district courts lacked the authority to issue universal injunctions. That case pertained not to health benefits, but to birthright citizenship. However, given the Court’s ruling in a case where constitutional rights were at issue, it seems that similar limitations would apply to district court injunctions in situations where the government seeks to enforce provisions of federal legislation. Accordingly, universal injunctions in cases challenging provisions of the Affordable Care Act (and other health benefits laws) may now be limited in scope to the plaintiffs in the litigation, and future plaintiffs challenging those provisions may now pursue more cumbersome class actions, as plaintiffs in the birthright citizenship cases are now doing.
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