Carl Schmid on Supreme Court Ruling Upholding ACA Preventive Coverage and Its Impact on HIV Prevention

In a 6–3 decision, the US Supreme Court upheld the Affordable Care Act’s requirement that private insurers cover preventive services recommended by the US Preventive Services Task Force (USPSTF) without cost sharing. The ruling, in Kennedy v Braidwood Management, has major implications for access to HIV prevention tools like pre-exposure prophylaxis (PrEP) and other critical screening services used by millions of Americans.

Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, called the decision “significant” and a win for public health protections. Reflecting on the broader impact of the ruling, Schmid noted its roots in bipartisan support for preventive care embedded in the original passage of the ACA, “When the Affordable Care Act was passed, Senator Harkin from Iowa emphasized the importance of focusing on prevention, not just treating people when they are sick. Everyone wanted their preventive services covered. We were up there pushing for coverage of things like HIV testing,” he explained.

Under the ACA, services given an “A” or “B” grade by USPSTF must be covered without cost sharing. This includes a wide range of services such as colonoscopies, lung cancer screenings, smoking cessation therapy, HIV and hepatitis testing, and PrEP, which reduces the risk of HIV transmission.

“PrEP wasn’t around when the ACA was passed, but it has since been reviewed and given an A rating twice by USPSTF. These drugs are highly effective in preventing HIV. This is how we get PrEP and other preventive services to the public,” Schmid said. “Most people get health insurance through private plans, which are subject to ACA provisions. If we had lost this case, all of that could have been at risk.”

The lawsuit originated in Texas and challenged the PrEP mandate on ideological grounds. Schmid addressed the motivations behind the case and the potential consequences if the law had been overturned. “This case originated from social conservatives in Texas who opposed covering PrEP, arguing that it promotes homosexuality and sex outside of marriage. But employers don’t know who among their employees might need PrEP. We shouldn’t pick and choose—we spread costs across the risk pool.”

“We’ve been fighting this case since March 2020—over five years—through lower courts, appeals courts, and now the Supreme Court. Around 150 million people use preventive services under this provision. So this is significant not only for our community, but for many others as well,” Schmid said.

Though the ruling preserves access to existing preventive services, Schmid emphasized that insurers’ compliance remains a concern, especially as newer forms of PrEP, including long-acting injectables, enter the market. “Because of this ruling, we’re back to where we were a few weeks ago. Insurers are supposed to cover all preventive services rated A or B by the USPSTF without cost sharing. But there have already been compliance issues,” he said. “We’ve seen cases where people are charged for parts of a covered service—like being billed for anesthesia during a colonoscopy, or for the visit itself, even when the service is preventive.”

He added that even with federal guidance requiring all forms of PrEP to be covered, insurers often create barriers. “There are several forms of PrEP. There’s the daily oral version, which is now available as a generic, as well as other oral drugs. There’s also an injectable version that’s administered every two months. Last year, the federal tri-agencies issued guidance stating that insurers must cover all forms of PrEP,” Schmid said.

“Despite this, we’re still hearing that people are facing prior authorization requirements and cost sharing for long-acting PrEP. These people need to report issues to their state insurance commissioners or the Department of Labor and push back on those barriers.” With the legal threat to preventive services resolved for now, Schmid said the next challenge is enforcement and education to ensure all individuals—regardless of income or background—can access the preventive care to which they are legally entitled.

Stay tuned for the rest of our interview with Schmid, where we explore how the ACA’s preventive coverage mandate may help sustain HIV and hepatitis prevention efforts in the face of proposed CDC funding cuts. We also examine how this Supreme Court ruling could impact ongoing barriers to access, including stigma, provider bias, and public awareness, and whether the Trump administration’s support for the ACA’s preventive services signals a broader shift in national HIV policy.

Reference

Supreme Court upholds preventive services coverage requirements. June 27, 2025. Accessed July 8, 2025. https://hivhep.org/press-releases/supreme-court-upholds-preventive-services-coverage-requirements/