Will the Supreme Court Kill Free Preventive Healthcare?

By Phil Rose, Health Contributor

What Braidwood v. Becerra Could Mean for Your Next Doctor Visit

You probably don’t think twice when your doctor orders a routine screening—maybe a cholesterol test, maybe a mammogram. And why would you? For years now, under the Affordable Care Act (ACA), those kinds of preventive services have been covered by insurance, often without you paying a dime.

But that could change very soon.

The Supreme Court has taken up a case—Braidwood v. Becerra—that might upend the way health insurance works in this country. It sounds technical (and it is), but the bottom line is simple: if the justices rule against the federal government, insurers could stop covering many of the preventive services we’ve all come to take for granted.

Wait, What Is This Case About?

At the center of the fight is a group of employers who argue they shouldn’t be forced to provide certain types of care—particularly things like HIV prevention drugs—to their employees. But this case isn’t just about that.

The real legal issue is more structural: they’re claiming the U.S. Preventive Services Task Force (USPSTF)—the panel that decides which services must be covered—is unconstitutional. Why? Because its members weren’t nominated by the President or confirmed by the Senate. And yet, their recommendations have real legal weight under the ACA.

That, according to the plaintiffs, violates the Constitution’s Appointments Clause. They argue it gives too much power to unelected people making decisions that affect the whole country.

What’s Actually at Risk?

This isn’t just a theoretical debate. If the Court agrees with the plaintiffs, here’s what could be affected:

• HIV prevention pills (PrEP)

• Mammograms, colonoscopies, and cancer screenings

• Cholesterol and blood pressure testing

• Smoking cessation and obesity counseling

• Routine vaccinations for both kids and adults

These are all services insurers are currently required to cover at no cost. But without the legal mandate, insurers could start adding co-pays, raising deductibles—or removing the coverage altogether.

Why It’s Bigger Than Just Healthcare

This case could have ripple effects far beyond whether your next physical includes a free test.

If the Supreme Court rules that USPSTF lacks the legal authority to set national coverage rules, it could open the door for broader attacks on how federal agencies work. Agencies like the CDC, the FDA, even the EPA—all of them rely on expert panels and delegated authority to make decisions without congressional micromanagement.

Legal scholars have been warning for a while: this is part of a larger push to weaken the so-called “administrative state.” Braidwood might just be the next domino.

Dr. Sara Rosenbaum, a professor of health law and policy at George Washington University, warned in The New York Times,

“This would be the first time a court has held that the preventive services provisions of the ACA are unconstitutional. It’s a huge deal.”

Where Things Stand Right Now

The Supreme Court has agreed to hear the case. Oral arguments are likely to happen in the fall, and a ruling is expected by summer 2025.

In the meantime, lower courts have issued a mix of rulings. One federal judge sided with Braidwood, striking down part of the ACA’s preventive care mandate. That ruling has been partially paused—so for now, insurers are still following the existing rules.

But make no mistake: this case is moving. And depending on how it lands, it could change how insurance coverage works by as early as 2026.

What Happens If the ACA Loses This Fight?

Let’s say the Supreme Court rules in favor of the plaintiffs. What then?

Insurers might begin phasing out free preventive coverage. Not all at once—but gradually. Some services might start coming with out-of-pocket costs. Employers might skip coverage for certain things, especially if they claim moral or religious objections. And unless Congress or state governments step in, there may not be much patients can do.

On the other hand, if the ACA wins, the current structure stays in place—and preventive care continues as it has for over a decade. But the legal questions raised in Braidwood won’t disappear. Similar challenges could pop up again, targeting other parts of the law.

What Can You Do Right Now?

This is one of those cases that could sneak up on people. So here’s what you can do to stay ahead of it:

• Take a look at your current health plan and see what preventive services are included.

• Stay informed. This case isn’t getting the headlines it deserves—but it will matter when renewal season rolls around.

• Support state-level action. Some states already have laws requiring insurers to cover certain preventive services. Others could pass similar protections, especially if federal rules collapse.

The bottom line? What the Supreme Court decides in Braidwood v. Becerra might not just affect policy—it could affect your next doctor’s appointment.

People Also Ask (PAA)

Is preventive care still free in 2025?
Yes—for now. The ACA still requires insurers to cover most preventive services at no cost, but that could change depending on the Court’s decision.

What does Braidwood v. Becerra challenge?
It argues that the federal task force making preventive care recommendations is unconstitutional because its members weren’t Senate-confirmed.

Could insurers start charging for screenings?
If the Court sides with the plaintiffs, yes—some insurers could start charging for services that are currently free.

Will states still be able to protect preventive care?
Yes. States can create their own mandates, and several already have laws in place to keep preventive services covered.