SOS 3700 Module 7 Written Assignment: The ACA and Braidwood Example

Free Screenings Survive, With a New Boss: The Affordable Care Act's Preventive Services Rule After Braidwood

Student Name

B.S. in Health Studies, Thomas Edison State University

SOS-3700: Challenges in U.S. and Global Public Health

Mentor Name

Month Day, Year

Free Screenings Survive, With a New Boss: The Affordable Care Act's Preventive Services Rule After Braidwood

Introduction

The Patient Protection and Affordable Care Act (ACA), signed in 2010, is the largest change to American health insurance since Medicare and Medicaid in 1965. Fifteen years later, it still shapes almost every coverage debate, and its provisions keep reaching the courts. This paper summarizes what the law changed and how it affected coverage, then examines one provision that the Supreme Court considered in 2025: the requirement that private insurers cover recommended preventive services without cost sharing.

What the Affordable Care Act Changed

The ACA expanded coverage in three main ways. Washington offered to pay most of the bill if states let adults with incomes near the poverty line, up to 138 percent of it, join Medicaid, an offer each state has been free to refuse since the Court's 2012 ruling. It created marketplaces where individuals could buy private plans with income-based subsidies. Children could also remain on a parent's policy through age 25, a change that reached young adults quickly (Wilensky & Teitelbaum, 2023).

The law also rewrote the rules of the insurance market. Insurers could no longer deny coverage or charge more because of preexisting conditions, impose lifetime limits on benefits or drop people when they became sick. Plans sold to individuals and small groups had to cover ten categories of essential health benefits. To keep the risk pool balanced, the law originally included a penalty for going without coverage, which Congress reduced to zero beginning in 2019.

Impact on Coverage and Health

The uninsured rate fell sharply after the major provisions took effect in 2014 and reached historic lows in the early 2020s. Research on the expansion has found that gaining coverage improves access to primary care and medications, reduces medical debt and financial strain and, in several studies, improves health outcomes and survival (Sommers et al., 2017). The gains were uneven: states that declined to expand Medicaid left many low-income adults without an affordable option, a gap that falls heavily on the South.

Coverage also changed how hospitals and clinics are paid. Hospitals in expansion states saw uncompensated care fall as more patients arrived with Medicaid, and community health centers gained a steadier revenue base. These financial effects matter for public health because they keep safety-net providers open in the neighborhoods that depend on them most.

In my office, the change is visible in small ways. Patients who once skipped annual visits because of cost now come in for physicals and screenings that their plans cover in full, and we spend less time arranging payment plans for routine care.

The Preventive Services Requirement

The ACA inserted Section 2713 into the Public Health Service Act, and it bars most private plans from charging patients anything, whether copay, coinsurance or deductible, for a defined list of preventive services (42 U.S.C. § 300gg-13). Coverage extends to every screening and counseling service the U.S. Preventive Services Task Force grades A or B, shots on the Advisory Committee on Immunization Practices schedule, and the women's and children's preventive care that federal health resources guidelines list. The list includes cancer screenings, blood pressure and cholesterol checks, depression screening and, since 2019, medication to prevent HIV infection, known as preexposure prophylaxis. Early studies of the cost-sharing change found mixed effects, with increased use of some services and little change in others (Han et al., 2015), but the provision removed a financial barrier for most privately insured Americans.

The Braidwood Challenge

In 2020, a Texas company, Braidwood Management, and several individuals sued. They objected on religious grounds to covering HIV prevention medication and argued that the task force's members, private experts who effectively decide what insurers must cover, had not been appointed as the Constitution requires for officers of the United States. A federal district court agreed and blocked enforcement of task force recommendations nationwide. The Fifth Circuit agreed that the appointments were unconstitutional but limited relief to the plaintiffs.

In Kennedy v. Braidwood Management (2025), the Supreme Court reversed in a six to three decision. The Court held that task force members are inferior officers, not principal officers, because the Secretary of Health and Human Services can remove them at will and can review and block their recommendations before those recommendations take effect. Inferior officers may be appointed by a department head, and the Secretary had ratified the members' appointments. The free coverage requirement therefore stands.

What the Ruling Means for Health Policy

The decision protected preventive coverage for tens of millions of people. Had the plaintiffs won broadly, insurers could have reintroduced cost sharing for screenings and HIV prevention, and evidence on cost sharing suggests that some patients would have skipped care as a result.

The reasoning, however, carries a second consequence. The Court saved the task force by emphasizing the Secretary's power over it. Recommendations that determine free coverage now plainly depend on a political appointee's supervision, not only on independent scientific review. That power was already visible in June 2025, when the Secretary removed all members of the Advisory Committee on Immunization Practices, the body whose vaccine recommendations also trigger free coverage under the same section. Whether this control strengthens accountability or politicizes prevention depends on who holds the office and how they use it.

Questions the Decision Leaves Open

The Court sent the case back to the lower courts on remaining issues, including whether the Secretary properly ratified recommendations made by the advisory bodies for vaccines and women's preventive care. The plaintiffs' religious objection to covering HIV prevention medication, which a lower court accepted for the plaintiffs themselves, was not before the Supreme Court. Employers and insurers will also watch whether future Secretaries use their review power to add, delay or remove recommendations. For public health, the practical question is whether the list of free preventive services will remain driven by evidence, as the statute intends, or will shift with each administration's priorities.

Conclusion

The ACA expanded coverage, rewrote insurance rules and made preventive care free at the point of service for most privately insured people. Braidwood preserved that last achievement, but it also confirmed that the experts who decide what counts as covered prevention answer to the Secretary. Future debates over preventive care may therefore turn less on courtrooms and more on the choices of the department that supervises the task force and advisory committees.

References

Han, X., Yabroff, K. R., Guy, G. P., Zheng, Z., & Jemal, A. (2015). Has recommended preventive service use increased after elimination of cost-sharing as part of the Affordable Care Act in the United States? Preventive Medicine, 78, 85-91. https://doi.org/10.1016/j.ypmed.2015.07.012

Kennedy v. Braidwood Management, Inc., No. 24-316 (U.S. June 27, 2025).

Sommers, B. D., Gawande, A. A., & Baicker, K. (2017). Health insurance coverage and health: What the recent evidence tells us. New England Journal of Medicine, 377(6), 586-593. https://doi.org/10.1056/NEJMsb1706645

42 U.S.C. § 300gg-13 (2024). Coverage of preventive health services.

Wilensky, S. E., & Teitelbaum, J. B. (2023). Essentials of health policy and law (5th ed.). Jones & Bartlett Learning.