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Health Care Costs, News & Updates

Braidwood’s Devastating Impact and What it Means for Our Care

Published On May 10, 2023

By: Allyson Horstman

What’s in your budget: cancer screenings or groceries? 

In a world where access to free preventive health care could be taken away, this is a question many of us may have to ask ourselves. 

The outcome of the Braidwood v. Becerra case may make that our reality. A federal judge in Texas ruled earlier this year that a portion of the preventive services mandate — the requirement that most health plans cover preventive care at zero out-of-pocket cost — was unconstitutional. 

In siding with the plaintiffs, the judge viewed the mandate to cover HIV PrEP, which is highly effective at preventing the transmission of HIV, as a violation of the Religious Freedom Restoration Act. The Braidwood plaintiffs argued that providing coverage for PrEP to their employees could encourage “homosexual behavior” and therefore was against their religious beliefs.

The specifics of the case hinge on the authority of the United States Preventive Services Task Force (USPSTF), an entity of national medical experts that issues recommendations about clinical preventive services that was created during the Reagan Administration. The Task Force makes evidence-based recommendations about health care services proven to provide a concrete health benefit. Cost-free access to many of these services, such as colorectal cancer screenings and mammograms, has saved millions of lives.

Though these experts are appointed by members of the executive branch, just as are many other government officials, the judge sees their role as a violation of the Appointments Clause, which directs how “Officers of the United States” shall be appointed.

In making this decision, the judge handed over decisions about health care to people’s employers and individual insurance companies. That’s bad — but this decision doesn’t just stop at PrEP. Ultimately, the judge’s decision means people’s access to free preventive care is at risk. A recent cross-appeal filed by the plaintiffs reveals their full intent – the elimination of all cost-free preventive services, including those recommended by the Advisory Committee on Immunization Practices (ACIP) and the Health Resources and Services Administration (HRSA), leaving people to pay for the care they relied on and accessed without cost for over a decade. 

On March 30th, the judge ruled that the scope of his decision is indeed nationwide, meaning that 151 million people nationally could lose access to no-cost preventive health care services. If the decision stands, we could start seeing new unaffordable costs for life-saving services. 

We have all seen the devastating impact inflation has had on our grocery bills and household budgets, leaving many to struggle to make ends meet. The exorbitant cost of medical care compounded with this loss of cost-free preventive services, exacerbates this financial burden. Already, half of U.S. adults have delayed or skipped recommended medical care because they felt they could not afford it, and a recent Morning Consult survey reported that 2 out of 5 U.S. adults would not pay for most preventive services if there was cost.

Lowering health care costs and providing preventive services without cost are supported across the political spectrum, and according to a Morning Consult poll from April, half of U.S. adults disapprove of the judge’s ruling. This ruling allows insurance companies to avoid paying for commonsense preventive care — and allows them to pass those costs over to you and me. Attacks on affordable health care, like those in Braidwood v. Becerra, do not represent the needs and priorities of people in the U.S. who are working hard to maintain the health of their families

While we wait for the appeals process to unfold and hopefully correct this ruling and reinstate protections for cost-free preventive care, state policymakers should take action to codify all preventive services protections. State legislatures should codify the preventive services coverage mandate into their state’s insurance codes for plans on the individual and small group markets, which cover around 17 million and 12 million people, respectively. Local lawmakers should also protect state employees by requiring the state government’s insurance to cover the preventive services recommended by the USPSTF, ACIP, and HRSA. United States of Care has developed a guide that outlines how state leaders and advocates can take steps to safeguard access to preventive services, which you can access here

A handful of states, such as California, Colorado, Hawaii, Massachusetts, Minnesota, New Mexico, Pennsylvania, and Rhode Island are already taking action to protect preventive services. As a direct response to the judge’s decision, lawmakers in Massachusetts introduced a bill (H-1081) that would require health plans to cover all services with an A or B rating according to the USPSTF without any cost to the patient. Colorado legislators recently passed SB23-189 which protects the rights of Coloradans enrolled in large employer plans to access preventive services, such as HIV PreP, at no out-of-pocket cost. 

We must also join together and call on employers and insurance companies across the nation to do the right thing and continue covering all the preventive services at no cost to their employees, regardless of the outcome of Braidwood and whatever comes after.

Inflation is already hard enough on the country right now, and we know the financial burden of medical care is already devastating to health outcomes. We cannot let more health care costs drive even more items to be left out of our household budgets.


About United States of Care

United States of Care is a nonpartisan organization committed to ensuring that everyone has access to quality, affordable health care.


Kevin Perez-Allen 

(714) 499-4481

[email protected]