US Supreme Court to hear clash over Obamacare preventive care on Monday

Washington: The US Supreme Court is set on Monday to consider the legality of a provision of the Obamacare law, formally called the Affordable Care Act, that helps ensure that health insurers cover preventive medical care such as cancer screenings at no cost to patients.

The federal government has appealed a lower court's determination that the US Preventive Services Task Force, which under Obamacare has a major hand in choosing what services will be covered, is composed of members who were not validly appointed. Its 16 members are appointed by the US secretary of health and human services without Senate confirmation. Several Texas Christians and two small businesses sued in federal court in Texas in 2020 to challenge the task force's structure. It is the latest in a years-long series of challenges to the 2010 law, Democratic former President Barack Obama's signature legislative achievement, to reach the Supreme Court.

If the justices uphold the lower court's ruling, health associations said in a filing, life-saving tests and treatments that have been cost-free would become subject to co-pays and deductibles, deterring many Americans from obtaining them.

The case centers on whether the Preventive Services Task Force wields power to such an extent that its members must be appointed by the president and confirmed by the US Senate, as required by the US Constitution's Appointments Clause, rather than the current arrangement.

The task force is made up of medical experts who serve four-year terms on a volunteer basis. It reviews medical evidence and public feedback and issues recommendations about which preventive services would be most effective for detecting illnesses earlier or addressing ailments before a patient's condition worsens. The task force has identified dozens of preventive services as having a high or moderate net benefit to patients including screenings to detect diabetes and various types of cancer, statin medications to lower the risk of heart disease and stroke, and interventions to help patients quit smoking or unhealthy alcohol use. The New Orleans-based 5th US Circuit Court of Appeals ruled in 2024 that the task force's structure violates the Constitution, as the plaintiffs claimed. The government's appeal of the 5th Circuit's decision initially was filed by Democratic former President Joe Biden's administration before being taken up by Republican President Donald Trump's administration.

Trump's administration argued in a Supreme Court brief that the task force's preventive care recommendations cannot become legally binding on insurers without the HHS secretary's permission.

"The secretary can remove them at will, and the threat of removal is the ultimate tool for control over final decisions on recommendations," Justice Department lawyers wrote.

For this and other reasons, Justice Department lawyers argued, the task force's members should be seen as so-called "inferior officers," meaning they can be lawfully appointed by an executive branch department head - like the HHS secretary - and do not require Senate confirmation under the Constitution.

In a Supreme Court filing, the plaintiffs argued that the Affordable Care Act has transformed the longstanding task force from an advisory body into one that now issues "decrees" to insurers, adding that the HHS secretary has no authority to stop task force recommendations from becoming binding law.

The task force's lack of supervision, they argued, makes its members "principal officers" who must be presidentially appointed and Senate confirmed under the Constitution.

Before the case was narrowed to the appointments issue, the lawsuit included a religious objection to being required to cover pre-exposure prophylaxis for HIV. They claimed that such drugs "facilitate and encourage homosexual behavior, prostitution, sexual promiscuity and intravenous drug use."

The 5th Circuit's ruling also rejected the government's request to remove certain offending words from the Obamacare provision at issue - a process called severing - in order to make that part of the law conform to the Constitution. That issue is also part of the appeal before the Supreme Court.

The Supreme Court's decision is expected by the end of June.