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1 1 (September 12, 2023)

handle is hein.crs/govemuy0001 and id is 1 raw text is: \Congressional ______ R esearch Service Preventive Services Access on the Docket in Braidwood v. Becerra September 12, 2023 Preventive care benefits for millions of privately insured individuals may be impacted by Braidwood Management Inc. et al. v. Becerra (Braidwood), an ongoing legal challenge to a federal requirement for coverage of clinical preventive services. Established by the Patient Protection and Affordable Care Act (ACA), this requirement generally compels most private-sector health plans and insurers to cover certain preventive services without cost-sharing (i.e., out-of-pocket costs) to their enrollees. A central issue in Braidwood is whether the preventive services requirement violates certain separation-of-powers principles of the U.S. Constitution, particularly the nondelegation doctrine and the Appointments Clause. In September 2022, a Texas district court dismissed most of the plaintiffs' constitutional claims, but concluded in part that covered services based on certain U.S. Preventive Service Task Force (PSTF or Task Force) recommendations were invalid. The district court's decision is stayed while the litigation proceeds in the U.S. Court of Appeals for the Fifth Circuit (Fifth Circuit). This Legal Sidebar provides background on the preventive services requirement, examines the Braidwood case, and discusses legal considerations for Congress. Background Clinical preventive care generally consists of routine medical services and items, such as immunizations, screening tests, and patient counseling, intended for promoting patient health and preventing illness. The ACA compels most private-sector, employment-based group health plans and health insurers offering insurance in the group and individual insurance markets to cover certain preventive health services with no out-of-pocket costs (such as a deductible or a co-pay) to plan participants. While the ACA does not specify each service that must be covered, the law directs plans and insurers to cover the following categories of services: Evidence-based items or services with a rating of A or B in the current PSTF recommendations Vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) Congressional Research Service https://crsreports.congress.gov LSB11040 CRS Legal Sidebar Prepared for Members and Committees of Congress

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