Supreme Court to Rule on Preventative Services Mandate

The U.S. Supreme Court heard oral arguments and will decide a critical case that could reshape ACA-mandated preventative services. This decision may impact employers, insurers, and employees in significant ways. 

Here’s what’s at stake, why these services play a crucial role, and how it could change benefits compliance. 

What’s the Issue? 

This case focuses on the U.S. Preventive Services Task Force (USPSTF). The group recommends which health services insurers must cover. Under the ACA, these recommendations ensure access to these services, including screenings and immunizations, without out-of-pocket costs.  However, a lower court ruled that USPSTF violated the Constitution’s Appointments Clause. It claimed the members were improperly appointed.  

If the Supreme Court affirms this ruling, insurers may no longer be required to follow USPSTF’s preventive care recommendations.  This could potentially revoke the ACA’s no-cost coverage mandate for preventative services. For employers, this may add challenges to managing group health plans and affects benefits compliance, costs, and employee satisfaction. 

Your Compliance Next Steps 

Employers and benefits professionals should act now to address potential changes. Here’s how to stay prepared: 

• Stay Updated 
  Track updates on this case. Understand how the decision might adjust compliance obligations.

• Review Your Plans 
  Assess how ending mandatory preventative services coverage impacts your benefits strategy, future costs, and overall employee satisfaction. 

• Check Employee Preventative Services Usage 
  Analyze how your workforce uses these services. Identify gaps to address if coverage changes occur. 

• Rely on Compliance Tools 
  Tools like ComplianceDashboard simplify managing compliance changes. You’ll benefit from tailored calendars and proactive reminders. 

What Happens Next? 

Should the plaintiffs prevail, employers may face new challenges with preventative services compliance. Here’s a look at possible outcomes: 

• Decisions for Employers 
  Employers may be forced choose whether to cover preventative services or shift some costs to employees. This may result in a decrease of the number of employees that seek these services. This initial decrease may result in increased care costs in the future for participants in the group health plan.  

• Confusion from State Laws 
  States with preventative services mandates will create additional compliance requirements for employers with insured plans. 

• Numerous states have preventative care protections in their state insurance code for fully insured plans.  Those protections may also be influx based on the outcome of this case.  

• Higher Costs for Employees 
  Employees might pay more for preventative services coverage, which could discourage participation in wellness programs and hurt overall health.  Today, over 150 million people, including 37 million children, with private insurance, access these services at no cost. 

• Changes to Insurance Policies 
  Insurers may restructure benefits, creating uneven preventative services coverage across plans and providers. 

These potential changes may place a higher administrative demand on HR professionals. Employers will need to manage multi-state regulations without universal preventative services standards, increasing the complexity of compliance.  Removing a universal guideline in favor of fragmented state and federal regulations would increase complexity for employers.  

The Final Word 

The Supreme Court will decide on preventative services mandates by June or July. That decision will shape health plan coverage and compliance requirements for employers. 

To stay ahead, employers should remain informed, examine health plans, and utilize compliance-management tools like ComplianceDashboard.