U.S. Supreme Court Upholds Affordable Care Act Preventive Benefits
On the last day of it Spring session, the U.S. Supreme Court issued its ruling affirming the constitutionality of preventive benefits provided under the Affordable Care Act (ACA). The ruling is a welcomed decision from the court and allows essential preventive services like lung cancer screening, tobacco cessation and HIV-prep to continue under ACA insurance plans.
The case before the court, Braidwood v. Kennedy, questioned the constitutionality of requiring insurance companies to provide, at no cost to the consumer, preventative health benefits recommended by the U.S. Preventative Health Services Taskforce and the Health Resources and Service Administration. In this case, a management company Braidwood Management challenged in federal court the requirement that businesses provide health insurance to their employees that cover USPSTF-recommended preventative services. Braidwood took issue with providing HIV-prep. Braidwood claimed the benefit was in violation of their religious beliefs and that it is not constitutionally permissible for the federal government to delegate coverage decisions to the USPSTF.
Originally, a lower court and a subsequent appeals court ruled in favor of Braidwood and instituted a nationwide injunction on coverage of USPSTF recommended benefits. The nationwide injunction was later scaled back by subsequent court action.
The case was finally heard by the U.S. Supreme Court this spring. The decision released by the U.S. Supreme Court today affirms the constitutionality and appropriateness of preventive services provided under the ACA and ensure patient access to approved preventive services – at no cost to the patients – going forward.
The ATS joined the American Medical Association and several other medical organizations in an amicus brief urging the U.S. Supreme Court to preserve the preventative health services under the Affordable Care Act.
"As a health care professional, I am relieved that the U.S. Supreme Court has affirmed the constitutionality of no-cost coverage of preventive services under the Affordable Care Act,” says Nicholas Kolaitis, MD, vice chair of the ATS Health Policy Committee. “This is a win for the patients I serve. We know preventive services like tobacco cessation and lung cancer screening save lives and are cost effective. I am grateful for the court’s decision and proud the ATS joined in the legal efforts to petition the court to protect preventive benefits for all our patients."
Senate Republicans Struggle to Advance Budget Reconciliation Bill
The ATS Washington Office is closely following the Senate’s consideration of a budget reconciliation bill, including Medicaid and the Affordable Care Act. The “budget reconciliation” refers to special legislative process that allows the Senate to pass major budget legislation with a simple majority – 51 votes – and avoid the 60-vote filibuster that threshold that all other Senate legislation must pass. However, for legislation to qualify for the budget reconciliation privileged status, all provision of the bill must have a direct impact on federal spending – either decreasing federal revenue (such as tax cuts or new federal expenditures like Social Security, Medicare or Medicaid) or increasing federal revenue (such as tax increases or cuts in federal expenditures like Social Security, Medicare or Medicaid).
The rule that determines whether a policy impacts federal revenues is known as the “Byrd rule” – named after the late Sen. Robert Byrd (D-WV) who designed budget reconciliation process – and is administered by the Senate Parliamentarian. Currently, the Senate Republican Leaders are working with Senate Parliamentarian’s office to determine which provisions of the Senate bill survive the Byrd rule and which need to be modified or removed to allow the bill to move forward under budget reconciliation privileged voting rules.
While the exact details of the discussions with the Parliamentarian are not shared with public, it is clear that several key provisions of the Senate Republican budget reconciliation bill have not survived the Byrd rule. In the climate change space, the original version of the Senate bill tried to terminate several climate change and clean energy programs created by the Biden Administration. The Parliamentarian ruled that the Senate could reclaim unobligated funds from these programs, but that the Senate bill could not eliminate the programs under budget reconciliation.
In the health care space, the Parliamentarian has ruled that several provision that would have impacted the Medicaid program and the Affordable Care Act program also do not pass the Byrd rule – including a key provision – provider specific taxes – that many states use to increase the federal share of Medicaid payments. Striking the provider specific taxes creates a significant budget hole in the Senate bill.
The Parliamentarian also ruled against a provision to revoke Medicare eligibility for non-citizen, including refugees, asylum seekers and residents with “temporary protected status.” The Senate provision sought to deny eligibility for these people even if they had paid Medicare taxes to earn eligibility and met other eligibility requirements. Further, the Parliamentarian ruled against a provision to deny Medicaid and Children’s Health Insurance Program (CHIP) coverage of adults and children whose immigration or citizenship status could not be immediately verified. The Senate provision sought strike the current 90-day window used to determine citizenship or immigration status.
The Parliamentarian also rejected a provision to reduce the federal match for state Medicaid expansion from 90 percent to 80 percent and rejected a provision that would ban federal Medicaid or CHIP funds from being used for gender affirming care.
While many of these Parliamentarian decisions were unwelcomed by the Senate Republican leadership, they were not necessarily surprising. In response to the Parliamentarian decisions, Senate Majority Leader Thune (R-SD), announced that he would not attempt to overrule the Parliamentarian’s decisions. The Senate Republican leadership will continue to revise the bill until key provisions pass the Byrd rule test.
President Trump’s goal of signing a bill by July 4 will most likely be pushed back as a result of the Parliamentarian decisions that require further tweaks to the bill. If the Senate does pass a bill, it will then go back to the House of Representatives for their consideration. House Members have already expressed their opposition to several of the provisions in the yet-to-be completed Senate bill.
The ATS continues to reach out the House and Senate to express our opposition to funding cuts and eligibility cuts to Medicaid, CHIP and the Affordable Care Act programs. The ATS Washington will continue to emphasize with Congress the essential role these programs play in providing access to quality medical care and preserving the fiscal health of physician practices, hospitals and other providers to serve patients.
VACCINES
HHS Sec. Kennedy Continues to Question US Vaccination Policy
This week saw continued controversy in U.S. policy on vaccinations. After firing all 17 members of the CDC Advisory Committee on Immunization Practices (ACIP) and repopulating the committee with 8 new members with limited vaccine expertise, the newly reconstituted panel met this week.
Prior to the ACIP meeting, on Monday, June 23, Senator Bill Cassidy (R-Louisiana), chair, Senate Health, Education, Labor and Pensions Committee posted on X that the June 25-26 meetings should be delayed. According to Sen. Cassidy, “Although the appointees to [the Advisory Committee on Immunization Practices] have scientific credentials, many do not have significant experience studying microbiology, epidemiology or immunology. In particular, some lack experience studying new technologies such as mRNA vaccines, and may even have a preconceived bias against them.”
The panel recommended that adults and children no longer receive flu vaccines containing trace amounts of thimerosal.The committee also voted to reaffirm the existing CDC recommendations that anyone six months and older receive the annual flu shot. Despite studies affirming the safety of thimerosal and previous CDC policy allowing its use, skeptics of vaccine safety have often focused on thimerosal as a potential cause of childhood autism. The panel also voted in favor of Merck’s monoclonal antibody shot that offers protection against RSV for infants younger than eight months.
The practical implications of the recommendation against flu vaccines that use thimerosal are limited. Very few vaccines still use thimerosal, however the panels’ recommendation against thimerosal is concerning in that is shows the reconstituted ACIP panel is willing to make recommendations that do not follow available science.
ATS Joins National Medical Organizations in Urging Reinstatement of CDC Vaccine Advisory Panel
This week, the ATS joined the American Medical Association and several other medical organizations in a letter to Secretary Robert F. Kennedy, Jr., strongly opposing the recent dismissal of all members of the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP).
The letter expresses deep concern over the unprecedented removal of the ACIP panel, which for over six decades has played a critical role in protecting public health through transparent, evidence-based vaccine recommendations. The letter urges Sec. Kennedy to immediately reinstate the terminated ACIP members and to maintain the longstanding, public process for selecting future members based on clinical expertise and experience. The letter also highlights the downstream effects policy changes like how private health plans base vaccine coverage decisions on CDC recommendations. Any disruption to ACIP’s work may lead insurers to reduce or eliminate coverage which cuts off access for many patients.
The ATS remains committed to ensuring broad, equitable access to safe and effective immunizations. The ATS urges the administration to uphold the integrity of the ACIP and to reaffirm its commitment to science-based policymaking in the interest of protecting the health of all Americans.
CLEAN AIR
U.S. Supreme Court Allows Fossil Fuel Companies to Challenge California Clean Cars Policy
The U.S. Supreme Court ruled this week that fossil fuels companies could sue California to block implementation of the state’s clean cars rules. Because the California clean cars rule impacts the manufacturing requirements for cars and trucks (and not directly fuel sources), a lower court had ruled that fossil fuel companies did not have standing to challenge the California rule. By a vote of seven to two, the U.S. Supreme Court reversed the lower court ruling and allowed the fossil fuel company challenge to the California waiver to proceed.
The U.S. Supreme Court ruling only addressed whether fossil fuel companies had a right to sue. The court’s decision does not address the merits of the fossil fuel companies’ complaint.
Under the Clean Air Act, California has the authority, with approval of EPA, to set vehicle tailpipe emissions standards that are more stringent than federal standards. During the Biden administration, California was granted waiver authority to require starting 2035 that all new vehicle sales be zero emission vehicles. Other states have the option of adopting the California policy. Several Republican led states and now the fossil fuel industry is suing in federal court to block implementation of California’s clean car policy.
The Trump Administration has announced that it will seek to rescind the clean cars waiver that EPA granted California during the Biden Administration.