The structure of the United States Preventive Services Task Force, known by the acronym USPSTF, is under scrutiny in a lawsuit brought by businesses and employees in the state of Texas. On Monday April 21st, the Supreme Court heard opening arguments in Kennedy vs. Braidwood Management, a case that will challenge the constitutionality of the task force as a decision-making entity.

The USPSTF is an independent group of national experts in prevention and evidence-based medicine that make recommendations to primary care clinicians about preventative services. After reviewing evidence on quality and strength on the benefits and harms of a preventative service, the committee issues a corresponding recommendation grade of A, B, C, D or I (insufficient evidence). Any services that receive a grade of A or B, indicating a high or moderate level of net benefit, are required under the Affordable Care Act to be covered by private insurers, Medicare and Medicaid.

Colorectal cancer screening for adults and statin use for the prevention of cardiovascular disease are among two of the many recommendations the USPSTF has made in the last few decades. Although, the USPSTF “does not consider the costs of a preventive service when determining a recommendation grade”, many of these preventive services are indeed cost-effective. A 2019 review analyzed 33 studies globally to assess the cost-effectiveness of colorectal screening, concluding “Ten-yearly colonoscopy, the most common CRC screening test in the United States, was optimal regarding cost effectiveness in most US studies.” Researchers generally conclude in favor of the use of statins as a cost-effective therapy for the prevention of coronary heart disease, which allow patients and insurers to avoid the costly complications that arise from untreated high cholesterol, as long as the cost of statins remains low.

If the Supreme Court rules in favor of Braidwood Management, the decision could undermine the legal authority of USPSTF recommendations under the Affordable Care Act, particularly those issued after the law’s enactment. Without a federal mandate requiring insurers to cover services graded A or B by the task force, private payers may begin making coverage decisions based on their own criteria. Patients may see cost-effectiveness analyses, which have historically been excluded from USPSTF determinations, begin to play a role in deciding which preventive services insurers choose to cover.

Regardless of the Supreme Court decision, it remains clear that treating cancer into its late stages or covering emergency visits for poorly controlled chronic conditions impose significant costs on payers and stress to the healthcare system. Continuing to offer preventive screenings and interventions is likely to remain in the best interest of both insurers, patients, and their families, as early detection is key to achieving better health outcomes in the United States.