Summary:
On June 27, 2025, the U.S. Supreme Court upheld the Affordable Care Act’s (ACA) requirement that private insurers and Medicaid expansion programs cover preventive services recommended by the United States Preventive Services Task Force (USPSTF) without cost-sharing. The 6-3 ruling in Kennedy v. Braidwood Management confirmed the constitutionality of USPSTF’s appointment structure, preserving access to critical preventive care for over 100 million Americans. The decision ensures continued coverage for services like HIV PrEP, cancer screenings, and immunizations, though future administrative actions could still influence USPSTF recommendations. This ruling reinforces the ACA’s role in reducing healthcare costs and improving public health outcomes.
What This Means for You:
- Continued No-Cost Preventive Care: Privately insured individuals retain access to essential screenings (e.g., mammograms, colonoscopies) and immunizations without copays or deductibles.
- HIV Prevention Protected: PrEP coverage remains intact, critical for high-risk populations given persistent racial/gender disparities in uptake.
- Monitor Policy Changes: The Trump administration may still alter USPSTF membership or delay recommendations—stay informed through KFF’s Preventive Services Tracker.
- Future Legal Battles: Pending lower-court cases could challenge other ACA preventive mandates (e.g., contraceptive coverage) on religious or procedural grounds.
Original Post:
On June 27, 2025, the U.S. Supreme Court issued the most recent opinion in a long history of challenges to different elements of the Affordable Care Act (ACA). In this case, Kennedy v. Braidwood Management, the Court ruled (6-3) that the ACA requirement that most private insurers and Medicaid expansion programs cover preventive services recommended by the United States Preventive Services Preventive Task Force (USPSTF) with no cost-sharing is constitutional. This means that these services continue to remain available without cost-sharing to most individuals with private coverage. About 100 million privately insured people get preventive services each year without cost-sharing under the ACA’s requirement.
Box 1: Preventive Services Coverage Requirements under the ACA
Section 2713 of the ACA requires most private health insurance plans and Medicaid expansion programs to cover recommended preventive services without any patient cost-sharing. Preventive services include a range of services such as screening tests, immunizations, behavioral counseling, and medications that can prevent the development or worsening of diseases and health conditions.
In its ruling, the Supreme Court held that the structure of the USPSTF does not violate the Constitution’s appointment clause. The Court agreed with the federal government, finding that the HHS Secretary has the power to remove USPSTF members at will and to review the recommendations they issue.
Box 2: The Challenge to USPTSF Recommendation to Cover PrEP for HIV Prevention
One service that could have been impacted by the court’s decision is pre-exposure prophylaxis (PrEP), a drug recommended by the USPSTF that reduces the risk of acquiring HIV by approximately 99% through sex and 74% through injection drug. The Court ruling means that those with private insurance can continue to have access to PrEP and associated services without cost-sharing.
The Supreme Court narrowly considered whether the structure of the USPSTF violates the Appointments Clause, but did not review other claims about ACIP or HRSA. Given ongoing litigation and the Trump administration’s recent actions on vaccine recommendations, this case is unlikely to be the final word on ACA preventive services coverage requirements.
Extra Information:
- USPSTF A/B Recommendations: Updated list of covered services under ACA Section 2713.
- CDC HIV Surveillance Data: Tracks PrEP disparities by race, gender, and geography.
People Also Ask About:
- Can employers opt out of covering PrEP? Currently, no—but religious exemptions may be argued in pending cases.
- Does this ruling affect Medicare/Medicaid? Yes for Medicaid expansion programs; traditional Medicare follows separate rules.
- How often does USPSTF update recommendations? Typically every 3–5 years, but delays may occur if membership changes.
Expert Opinion:
“This ruling is a temporary reprieve for preventive care access,” says Dr. Alina Salganicoff of KFF. “The administration’s power to reshape USPSTF—as seen with ACIP—could destabilize evidence-based coverage and amplify health inequities, particularly for LGBTQ+ and communities of color reliant on PrEP.”
Key Terms:
- ACA preventive services no-cost coverage
- USPSTF recommendations update 2025
- HIV PrEP insurance mandate
- Supreme Court Braidwood decision impact
- Preventive care cost-sharing waiver
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