Legal, medical and public health experts reflect on Kennedy v. Braidwood ruling’s implications
The Supreme Court ruling in the case of Kennedy v. Braidwood Management preserves the Affordable Care Act provision that makes certain preventive care available to patients at no cost to them, as long as they meet criteria laid out in the recommendations of the U.S. Preventive Services Task Force.
University of Michigan experts discuss the outcome of the case and its implications.
Nicholas Bagley
Nicholas Bagley, a professor at the Law School, has analyzed and written on Kennedy v. Braidwood since it began. In April, he wrote about the issue of the nature of the U.S. Preventive Services Task Force members’ appointments and the ability of the Health and Human Services secretary to remove them.
“The big takeaway here is that the task force’s recommendations are binding, just as the ACA’s drafters intended. But the scheme is constitutional only because (HHS Secretary) Kennedy can exercise near-complete control over task force recommendations. A mixed bag!” he said on social media.
Bagley’s social media thread explaining the ruling, using snippets from the court’s decision.
A. Mark Fendrick is a professor of internal medicine at the Medical School and director of the Center for Value-Based Insurance Design. He has spent more than 20 years studying the impacts of out-of-pocket costs on the decisions that patients and providers make about care, and his work helped inform the design of the ACA provision at the heart of the case.
“Because prevention and early detection play such a critical role in reducing the clinical and economic burden of chronic diseases, access to effective screening is foundational,” he said. “The Supreme Court’s decision to preserve the extremely popular ACA requirement that insurance plans cover preventive services receiving an A or B rating by the United States Preventive Services Task Force at no cost (i.e., copays, coinsurance or deductibles) to patients is a win for patients, clinicians and the strained U.S. delivery system.
“The provision enhances coverage for over 200 million insured Americans, about 60% of whom use at least one of the covered services each year, leading to better patient outcomes and in some instances lower medical costs.
“Clinicians rely heavily on the recommendations provided by the carefully vetted USPSTF. In a new environment where the USPSTF members are selected by the secretary, clinicians may need to turn to other sources to find unbiased scientific information needed to advise patients. Such a change will add further complexity to the already overburdened workforce and possible confusion for patients.
“Given that many insured Americans who are eligible for no-cost preventive care have not received these potentially lifesaving services, the court’s decision offers a ‘second chance’ for key constituents, including those who initiate screening and diagnose and treat these conditions, to better educate eligible individuals about no-cost screening and to help them navigate the screening continuum.”
Minal Patel
Minal Patel, professor of health behavior and health equity at the School of Public Health, studies how the financial burden of chronic illness affects people’s ability to manage their health.
“Today’s decision recognizes something fundamental: Prevention isn’t a luxury—it’s how we help people live out what’s possible in their lives,” she said. “When we see cancer diagnoses happening in younger and younger people, it’s a reminder that early detection through accessible screening can be the difference between a treatable condition and a life cut short.
“By preserving no-cost preventive care, the court is saying that a person’s ability to catch health problems early shouldn’t depend on their ability to pay a copay. This means more parents will be there for their children’s milestones, more young adults will get the early interventions that set them up for healthy and fulfilling futures, and more families won’t have to choose between a screening today and paying for groceries this week.”
Diane Harper
Diane Harper is a professor of family medicine at the Medical School who has studied both cervical cancer screening and the vaccine against the human papillomavirus that’s designed to prevent cervical cancer. Both are services covered by the ACA provision, though follow-up testing of screening is not, which leads some patients not to follow up on abnormal results because of cost. Last year, she and colleagues published a study on the potential impact of more eligible individuals receiving screening and follow-up tests
“The work of the USPSTF by the expert generalists who provide the population perspective on health issues is absolutely necessary,” she said. “This group advances changes in health care practice based on solid evidence from a population perspective. I sincerely hope that the USPSTF remains an apolitical body that is well balanced in generalist specialties to provide guidance to update clinical care.”
Geoffrey Hoffman
Geoffrey Hoffman is an associate professor at the School of Nursing who studies fall prevention and fall-related injuries in older adults. In a recent commentary in the Journal of the American Geriatrics Society, he wrote about the implications of the case for coverage of exercise-based programs recommended by the USPSTF to help reduce the risk of falls in older adults.
“Policies that enhance—rather than decrease—access to fall prevention screenings and interventions are warranted,” he said. The ruling “offers a ‘second chance’ for key constituents, including those who assess fall risk and provide interventions to prevent falls and treat their complications, to better educate eligible patients about the benefits of screening for and intervening in order to prevent falls.
“Increased risk assessment and uptake of preventive no-cost exercise interventions to prevent falls would improve patient well-being, reduce medical expenditures, and create a rare ‘win-win-win’ scenario for patients, clinicians and the Medicare program.”
Anna Lok
Anna Lok and Elliot Tapper are hepatologists and professors of internal medicine at the Medical School who recently wrote an article on the potential effect of today’s ruling on efforts to cure hepatitis C.
A one-time hepatitis C screening is among the preventive services currently recommended by the USPSTF. The treatment of hepatitis C has been transformed by direct-acting antivirals, which can cure 95% of cases. Individuals can only be cured, however, if they are diagnosed in a timely fashion.
“It is important to continue to support all current recommendations by the U.S. Preventive Services Task Force,” said Lok, director of clinical hepatology at U-M Health. “Changes to those recommendations must be guided by scientific evidence, including inputs from experts and the public.”
Elliot Tapper
“Knowledge is power: We cannot save lives from hepatitis C if we do not know who has it,” said Tapper, director of the U-M Health Cirrhosis Program. “The only way to know is through testing. As people who care deeply about preventing the harms and costs of cirrhosis and liver cancer, we hope that the future is free of barriers to testing.”
David Hutton
David Hutton is a professor of health management and policy and of global public health at the School of Public Health, as well as professor of industrial and operations engineering at the College of Engineering. His research is focused on health policy and medical decisions, particularly the mathematical models to assist with the allocation of resources for health. He has served as consultant, adviser and collaborator with the World Health Organization, U.S. Department of Health and Human Services, and the U.S. Centers for Disease Control and Prevention.
Kao-Ping Chua
Kao-Ping Chua, associate professor of pediatrics at the Medical School and director of the Susan B. Meister Child Health Evaluation and Research Center, reflects that the court case that led to today’s ruling began over the issue of providing pre-exposure prophylaxis, or PrEP, medication to patients at high risk of acquiring HIV, the virus that causes AIDS. Chua and colleagues led by Nina Hill recently published a study showing that the use of PrEP in young adults grew eightfold in the first decade it was available. PrEP was first recommended by the USPSTF in 2019.
Ella Kazerooni
Ella Kazerooni is a professor of radiology and internal medicine at the Medical School and inaugural chair of the American Cancer Society’s Lung Cancer Screening Roundtable. Low-dose computed tomography screening for lung cancer is among the recommended services.
“Lung cancer is the leading cause of cancer death in United States among both men and women,” she said. “Lung cancer screening with low-dose CT is the No. 1 way to prevent these deaths. Today’s action by the Supreme Court maintains the ability of all eligible individuals to continue to receive this life-saving test with no copay required by their private insurance.”