The Supreme Court is currently deliberating on Kennedy v. Braidwood Management, a case questioning the constitutionality of the U.S. Preventive Services Task Force (USPSTF) under the Appointments Clause. This stems from the Affordable Care Act's (ACA) requirement for employer-sponsored health plans to cover USPSTF-approved preventive care without cost-sharing. A district court and the 5th Circuit Court of Appeals have previously ruled that the USPSTF's composition violates constitutional appointment procedures. The final decision could significantly impact employers' obligations regarding preventive care coverage. Additionally, religious objections to specific services like oral contraceptives and HIV prevention medication (PrEP) complicate the matter further. The court has multiple options, ranging from narrow rulings affecting only the plaintiffs to broader decisions potentially eliminating all preventive service mandates under the ACA.

In this legal battle, the Supreme Court's ruling could reshape how preventive healthcare is provided in employer-sponsored health plans. Initially, a lower court found that the USPSTF was improperly constituted because its members were not appointed according to constitutional requirements. Subsequently, the 5th Circuit upheld this decision. The plaintiffs also raised concerns about covering certain medications based on their religious beliefs, an issue remanded back to the district court for further analysis. Depending on the outcome, the scope of required preventive care coverage could drastically change, possibly excluding services recommended post-2010, such as screenings for lung and colon cancer or medications preventing heart disease and HIV transmission.

Preventive healthcare plays a crucial role in saving lives and improving overall health outcomes. Regardless of the Supreme Court's decision, there are compelling reasons for employers to continue offering preventive services without additional costs. Removing cost-sharing barriers typically increases utilization of medical services, aligning with value-based insurance design principles. For instance, more than one-third of respondents in a recent survey indicated they would avoid preventive services if not covered by insurance. Furthermore, high-deductible health plans (HDHPs) pose challenges for many insured individuals who must pay out-of-pocket until meeting their deductibles, emphasizing the importance of maintaining no-cost preventive care.

Providing comprehensive preventive care coverage remains economically viable for most services. Many preventive measures, such as drug use screenings or mental health referrals, can be integrated into existing office visits with minimal incremental costs. Blood tests recommended by the USPSTF generally cost less than $50 each, while expensive procedures like colonoscopies are infrequent due to their once-a-decade recommendation schedule. Moreover, preventive services enjoy widespread popularity among insured populations, with approximately 60% utilizing these benefits in 2018. Public opinion surveys reveal strong support for requiring full insurance coverage of preventive care, making it a highly valued aspect of the ACA across political lines.

Maintaining current scientific evidence as a guide for designing plan benefits ensures optimal healthcare delivery. A potential shift to pre-2010 guidelines could reduce overall benefits gained from preventive care. For example, adjusting colon cancer screening age from 50 to 45 addresses rising incidence rates in younger populations at a reasonable cost. Similarly, updated recommendations since 2010 have refined cervical cancer screening intervals and expanded sexually transmitted infection screenings. Employers considering changes should weigh the implications carefully, ensuring alignment with the latest evidence-based practices.

State-level mandates for preventive care coverage apply exclusively to fully insured state-regulated plans, leaving self-funded plans unaffected. To preserve consistency across different types of health plans, employers might opt to maintain full preventive care coverage voluntarily. Tax regulations allow preventive care coverage under high-deductible health plans without jeopardizing Health Savings Account advantages, providing another incentive for continued inclusion. Employee expectations have evolved over the past decade, expecting full preventive care coverage as a standard benefit. Demonstrating commitment to employee well-being through sustained coverage fosters loyalty, reduces turnover, and enhances productivity.

As the Supreme Court prepares its decision, anticipated later this spring or early summer, employers face potential uncertainty in health plan designs. Despite modest costs associated with providing preventive care coverage, continuing this practice offers significant health benefits and reinforces employer support for employees. By prioritizing preventive care, companies can enhance member health outcomes while showcasing tangible care for their workforce.