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In April, the Supreme Court will hear the case Kennedy (Becerra) v. Braidwood Mgmt. challenging what must be covered by group health plans without cost-sharing as preventive. Specifically, the Supreme Court will rule on whether the U.S. Preventive Services Task Force (USPSTF) has the authority to make recommendations on preventive care.

If the Supreme Court decides that the USPSTF does not have the authority to make such recommendations, group health plans would be allowed to impose cost-sharing for any preventive care recommendations that have been made or updated since the Affordable Care Act (ACA) went into effect back in 2010. Group health plans could, but would no longer be required, to cover certain treatment and services without cost-sharing.

obÌåÓý Compliance Note: It’s difficult to predict how the Supreme Court might rule in this case, but we do have a sense of the landscape favoring a strong executive branch during the Trump Administration.

An important distinction in this case being asserted is that the Secretary of Health and Human Services (HHS) ultimately has the right to sign off on the recommendations of the USPSTF, and this right means the recommendations fall within the Secretary’s authority (who is duly appointed by the President).

Based on the above point and lack of precedent for the Supreme Court ruling in favor of dismantling significant ACA components, one might expect that the Supreme Court will uphold the recommendations of the USPSTF. Meaning, group health plans won’t be impacted.

Employer Action

Stay tuned for developments that may affect employer-sponsored coverage. obÌåÓý will issue updates as they become available.

obÌåÓý will continue to monitor regulator guidance and offer meaningful, practical, timely information. This material should not be considered as a substitute for legal, tax and/or actuarial advice. Contact the appropriate professional counsel for such matters. These materials are not exhaustive and are subject to possible changes in applicable laws, rules, and regulations and their interpretations.

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