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The Supreme Court on Monday will hear arguments in Kennedy v. Braidwood, the first significant challenge to the Affordable Care Act under the current Trump administration and a case that could strip away insurance coverage for preventive services like cancer screenings, HIV prevention and diabetes medication for millions of Americans.
The case has its origins in a 2020 legal challenge by Braidwood Management, Inc., a Texas-based Christian company that sued the federal government and claimed providing coverage for PrEP — an HIV preventive medication also known as pre-exposure prophylaxis — violated its rights under the Religious Freedom Restoration Act.
At the time, Dr. Steven Hotze, the sole trustee and beneficiary of the Braidwood Management company, said he was unwilling to pay for PrEP or STI screenings for his employees. “They are consequences of a patient’s choice to engage in drug use, prostitution, homosexual conduct, or sexual promiscuity – all of which are contrary to Dr. Hotze’s sincere religious beliefs,” the complaint read.
The central question before the Supreme Court now is not about religious beliefs. Instead, the justices have been asked to weigh in on whether an independent task force has the authority to recommend preventive services like PrEP be covered by health insurers under the U.S. Constitution.
The United States Preventive Services Task Force is an independent group of volunteer medical experts who work outside of the federal government, although they are appointed by the secretary of the Department of Health and Human Services and their work is supported by an agency within HHS.
Under the 2010 landmark Affordable Care Act, signed by President Barack Obama, private insurers are required to cover preventive services that are recommended by the task force.
If the Supreme Court rules in favor of Braidwood, however, private health insurers would no longer be required to fully cover preventive services and in turn, would make health care more expensive by adding on copays, deductibles or coinsurance to consumers.
The outcome of the case could have widespread ramifications for 150 million Americans on private insurance. Thirty-six states don’t currently already have protections for coverage of preventive care built into their state insurance plans.
Public health advocates warn that people who need the care the most would be deterred from accessing it altogether.
In the lawsuit, Braidwood argues that the task force wields too much power to determine what types of preventive care are covered under the ACA and does not get enough oversight from the health secretary. In 2022, a district court sided with Braidwood and also ruled that forcing coverage of PrEP violated the company’s religious freedoms.
The Biden administration appealed the decision in 2024. The 5th U.S. Circuit Court of Appeals upheld the lower court’s ruling, stating that the task force wielded “unreviewable power.”
After President Joe Biden left office, the Trump administration agreed to pick up the case and defend the task force. The Justice Department has argued that because the HHS secretary can remove task force members at any moment, the secretary has the appropriate oversight over the group.
The lawyer representing Braidwood is Jonathan Mitchell, an anti-abortion activist who represented President Donald Trump when Colorado tried to exclude him from its 2024 presidential ballot.
Leslie McGorman, the director of policy and strategy at AIDS United, said the fact that the Trump administration is defending this case in court and making the same argument as the Biden administration “could potentially be a bright spot.”
But she said her optimism only goes so far, as oral arguments for the case come less than a month after HHS Secretary Robert F. Kennedy Jr. shrunk the Centers for Disease Control and Prevention and eliminated entire offices dedicated to HIV prevention and treatment. Last month, the administration also quietly proposed a rule that would dismantle many parts of the ACA.
“There’s an inevitable chasm that continues to grow between those who have private insurance and those who rely on the government for their health care needs,” McGorman said about the recent restructuring of HHS. “We just have less and less interest from this administration to really care at all about the safety net.”
“Certain groups — trans folks, queer folks, people vulnerable to HIV — are the lowest hanging fruit and are often used as a placeholder for something that’s going to impact a much larger group.”
– Mandisa Moore-O’Neal, executive director of the Center for HIV Law and Policy
McGorman and other HIV and LGBTQ+ advocates worry that a Supreme Court decision axing no-cost preventive services could further exacerbate existing health disparities between marginalized communities and other Americans.
Almost two-thirds of the 1.2 million people who could benefit from PrEP are not taking it, even though the medication is widely available, CDC data shows. Black and Latino communities, gay and bisexual men, trans women, and people living in the South and rural areas experience some of the highest rates of new HIV infections, while facing significant barriers in accessing heath care, including PrEP, due to financial barriers, lack of insurance or discrimination in medical settings.
“PrEP was explicitly named from the Braidwood group because [they believe] it promotes homosexuality and unmarried sex … but the goal was always to undermine the Affordable Care Act,” Mandisa Moore-O’Neal, the executive director of the Center for HIV Law and Policy, told HuffPost. “Braidwood really drives home how certain groups — trans folks, queer folks, people vulnerable to HIV — are the lowest hanging fruit and are often used as a placeholder for something that’s going to impact a much larger group.”
Without access to no-cost PrEP, experts warn there could be an increase in HIV infections, especially as Kennedy continues to decimate numerous offices in HHS tasked with overseeing HIV prevention, surveillance and research and implementing strategies to address disparities across race, gender and sexual orientation. Experts caution that Kennedy’s overhaul of HHS has already threatened the decades of progress made toward ending the HIV epidemic domestically and abroad.
An end to the “PrEP Mandate” would result in an additional 2,083 new HIV infections a year in the United States, up from a base of 28,200 infections, according to a 2023 report from Yale University. A single new HIV infection would cost, at minimum, $420,000 for a lifetime of treatment, the study found.
The elimination of coverage for preventive care would spell trouble for dozens of preventive health care services beyond just PrEP, including statins to prevent heart disease, lung cancer screenings, depression and suicide risk screenings, and various pregnancy screenings.
“The fear is that this will be a big step backwards in reducing the burden of cancer,” Scott Ramsey, a cancer researcher and physician at the Fred Hutchinson Cancer Center, told STAT News. Even a $20 copay can deter people from getting cancer screenings, he said, which could lead to people being diagnosed with cancer at more advanced stages of the disease.
Many people will be in limbo while they wait for a ruling on the case, which is expected in June.
“What does that mean for someone at the end of year? What about for a queer couple who has been planning pregnancy and hopes to start insemination in July and was counting on being able to use their insurance to have certain early pregnancy screenings? What is the impact on Black women’s ability to get cancer screenings?” Moore-O’Neal asked, referring to the possibility that the court could rule in favor of Braidwood. “The impacts are dire.”
Former task force members are also concerned that Kennedy could make changes to the group that jeopardize its neutrality or ability to make science-based recommendations. In a letter to the health secretary, 34 former members warned that “a loss in this case may mean millions of Americans will be deprived of access to free, effective preventive care.”
“We want to be sure that there isn’t an unintended outcome of the newly announced reorganization of the Department of Health and Human Services, including the Agency for Healthcare Research and Quality (AHRQ), which damages the Task Force’s ability to help prevent chronic disease through primary care services,” the letter read.