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Published online by Cambridge University Press: 30 December 2024
Braidwood Management, Inc. v. Becerra threatens the nationwide enforceability of the preventive care mandate of the Affordable Care Act (ACA) with respect to a variety of preventive health care services. The success of this lawsuit could have devastating repercussions. Not only would many current guidelines of the U.S. Preventive Services Task Force (USPSTF) be affected, but future preventive care recommendations would be as well, to the detriment of achieving health equity goals. This Article posits that the loss of guaranteed free preventive care could threaten current and future health equity gains. If preventive care is no longer offered without cost-sharing, research shows that many people, especially those with lower socioeconomic status, will not access the care. This decrease in access to recommended screenings and other preventive services would likely decrease uptake, over time impacting the stage at which diseases such as cancer are diagnosed, making late-stage diagnoses with poorer prognoses more common, and increasing transmission of other conditions such as HIV. At the population level, decreased access to free preventive care could hinder efforts to reduce entrenched inequalities associated with these conditions.
Moreover, these effects will be amplified as insured people lose access to preventive care recommendations that evolve in response to new research findings. In the years since the ACA’s passage, the USPSTF has brought a health equity lens to each step of its recommendation process, including how it chooses preventive services to study, how it designs and conducts its research plan, and its approach to issuing recommendations along with calls for more research. Although some have argued that the resulting shift in the USPSTF’s recommendations has not happened fast enough, the way in which the USPSTF structures its evidentiary reviews — with a focus on high-level literature reviews of medical studies — suggests that over time, as individual studies continue to examine the effectiveness of interventions in different populations and publish their results, the shift will become more dramatic and the resulting recommendations will be more effective at combating health care disparities. If Braidwood is successful, no-cost insurance coverage for these more responsive recommended services could be undermined.
This Article explores the potential impact Braidwood could have on existing and anticipated advances in preventive care through a focus on two life-threatening conditions: cancer and HIV. Both cancer and HIV preventive care recommendations have undergone significant changes since the implementation of the preventive care mandate. While the resulting recommendations remain imperfect, the Article shows the important and evolving relationship between these recommendations and efforts to overcome pervasive and entrenched disparities in health outcomes related to these conditions. If Braidwood is upheld, ongoing efforts to reduce disparities in cancer and HIV will be stymied.
1 Preventive Services, HealthCare.gov, https://www.healthcare.gov/glossary/preventive-services/ [https://perma.cc/HY72-RNED].
2 See Paul Reed, An Ounce of Prevention…Can Save a Person’s Life, Health.gov: Health & Well-Being Matter (Aug. 26, 2022), https://health.gov/news/202208/ounce-prevention-can-save-persons-life [https://perma.cc/K5JT-7LRF] (“Preventive services can … identify health problems early … when clinical interventions are most beneficial.”).
3 See, e.g., Leslie R Martin et al., The Challenge of Patient Adherence, 1 Therapeutics & Clinical Risk Mgmt. 189, 190 (2005).
4 Clinical and Equity Implications of Braidwood v. Becerra, Ctr. for Value-Based Ins. Design (June 2, 2023), https://vbidcenter.org/clinical-and-equity-implications-of-braidwood-v-becerra [https://perma.cc/H35U-5BAZ].
5 Geetesh Solanki et al., The Direct and Indirect Effects of Cost-Sharing on the Use of Preventive Services, 34 Health Servs. Rsch. 1331, 1339-40, 1348 (2000).
6 Ricky Zipp, Many Americans Are Likely to Skip Preventive Care if ACA Coverage Falls Through, Morning Consult Pro (Mar. 8, 2023, 5:00 AM), https://pro.morningconsult.com/trend-setters/affordable-care-act-polling-data [https://perma.cc/775B-QX9N].
7 See, e.g., Lunna Lopes et al., Americans’ Challenges with Health Care Costs, KFF (March 1, 2024), https://www.kff.org/health-costs/issue-brief/americans-challenges-with-health-care-costs/.
8 Dhruv Khullar & Dave A. Chokshi, Health, Income, & Poverty: Where We Are & What Could Help, Health Affs.: Health Pol’y Brief, Oct. 4, 2018, at 2.
9 Obama’s Health Care Speech to Congress, N.Y. Times (Sept. 9, 2009), https://www.nytimes.com/2009/09/10/us/politics/10obama.text.html [https://perma.cc/9YX6-TQGP].
10 Patient Protection and Affordable Care Act, Pub. L. No. 111-148, § 2713, 124 Stat. 119, 131-32 (2010) (codified as amended at 42 U.S.C. § 300gg-13).
11 Id.
12 Background: The Affordable Care Act’s New Rules on Preventive Care, Ctrs. for Medicare & Medicaid Servs. (July 14, 2010), https://www.cms.gov/cciio/resources/fact-sheets-and-faqs/preventive-care-background [https://perma.cc/K27G-WK8X].
13 Matthew J. O’Brien et al., Reducing Health Disparities Through Prevention: Role of the U.S. Preventive Services Task Force, 58 Am. J. Preventive Med. 724, 724 (2020).
14 We recognize that there are many ways of referring to different racial and ethnic groups. See, e.g., Catherine Lewis et al., Race and Ethnic Categories: A Brief Review of Global Terms and Nomenclature, Cureus, July 1, 2023, at 1, passim. In this Article, we will aim to use consistent terminology recognized by the National Institutes of Health, see id. at 2 tbl.1, adjusted in individual circumstances as necessary to accurately reflect research data.
15 Michelle Tong et al., Racial Disparities in Cancer Outcomes, Screening, and Treatment, KFF (Feb. 3, 2022), https://www.kff.org/racial-equity-and-health-policy/issue-brief/racial-disparities-in-cancer-outcomes-screening-and-treatment/ [https://perma.cc/QB7L-DWWP].
16 See Impact on Racial and Ethnic Minorities, HIV.gov (Dec. 18, 2023), https://www.hiv.gov/hiv-basics/overview/data-and-trends/impact-on-racial-and-ethnic-minorities/ [https://perma.cc/Q5M6-GV9P]; Black Americans and HIV/AIDS: The Basics, KFF (Feb. 7, 2020), https://www.kff.org/hivaids/fact-sheet/black-americans-and-hivaids-the-basics/ [https://perma.cc/6Y8N-AA6D]; HIV/AIDS and Hispanic Americans, Off. of Minority Health, U.S. Dep’t of Health & Hum. Servs., https://minorityhealth.hhs.gov/hivaids-and-hispanic-americans [https://perma.cc/S4T4-N4CR].
17 Eliseo J. Pérez-Stable & Monica Webb Hooper, The Pillars of Health Disparities Science—Race, Ethnicity, and Socioeconomic Status, JAMA Health F., Dec. 21, 2023, at 1-2.
18 See Dhruv Khullar & Dave A. Chokshi, supra note 8, at 2.
19 Daniel Redondo-Sánchez et al., Socio-Economic Inequalities in Lung Cancer Outcomes: An Overview of Systematic Reviews, Cancers, Jan. 13, 2022, at 2.
20 Jennifer A. Pellowski et al., A Pandemic of the Poor: Social Disadvantage and the U.S. HIV Epidemic, 68 Am. Psych. 197, passim (2013).
21 See Maria De Jesus, To End the HIV Epidemic, Addressing Poverty and Inequities One of Most Important Treatments, Conversation (Feb. 14, 2019, 6:48 AM), https://theconversation.com/to-end-the-hiv-epidemic-addressing-poverty-and-inequities-one-of-most-important-treatments-111484 [https://perma.cc/6CLD-TH8A].
23 David R. Williams et al., Understanding Associations Among Race, Socioeconomic Status and Health: Patterns and Prospects, 35 Health Psych. 407, 408 (2016).
24 Poverty Rate by Race/Ethnicity, 2022, KFF, https://www.kff.org/other/state-indicator/poverty-rate-by-raceethnicity/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D [https://perma.cc/5CYJ-JKLG].
25 Stephanie M. Hernandez et al., Sexual Orientation, Gender Expression and Socioeconomic Status in the National Longitudinal Study of Adolescent to Adult Health, 78 J. Epidemiology & Cmty. Health 121, 121 (2024).
26 HIV and African American Gay and Bisexual Men: Prevention Challenges, Ctrs. for Disease Control & Prevention, https://www.cdc.gov/hiv/group/bmsm/prevention-challenges.html [https://perma.cc/3VWE-NPC7] (last reviewed Sept. 14, 2022); see Brian Mustanski et al., Individual and Network Factors Associated with Racial Disparities in HIV Among Young Men Who Have Sex with Men: Results from the RADAR Cohort Study, 80 J. Acquired Immune Deficiency Syndromes 24, 28-29 (2019).
27 See Nambi Ndugga & Samantha Artiga, Disparities in Health and Health Care: 5 Key Questions and Answers, KFF (Apr. 21, 2023), https://www.kff.org/racial-equity-and-health-policy/issue-brief/disparities-in-health-and-health-care-5-key-question-and-answers/ [https://perma.cc/UDD6-PM23] (“A broad array of factors within and beyond the health care system drive disparities in health and health care.” (citation omitted)).
28 Tong et al., supra note 15.
29 PrEP for HIV Prevention in the U.S., Ctrs. for Disease Control & Prevention (Sept. 29, 2023), https://www.cdc.gov/nchhstp/newsroom/fact-sheets/hiv/PrEP-for-hiv-prevention-in-the-US-factsheet.html [https://perma.cc/6N7U-VY69].
30 Timothy S. Carey et al., National Institutes of Health Pathways to Prevention Workshop: Achieving Health Equity in Preventive Services, Annals Internal Med. 272, 276 (2020).
31 For example, in western New York, which has high rates of lung cancer incidence and death — with the greatest impact in communities of color and rural areas — Roswell Park Comprehensive Cancer Center has designed a mobile screening and outreach program that brings lung cancer screening through low-dose computed tomography (“LCDT”) directly to high-need areas. Fact Sheet: White House Details Progress from the Cancer Cabinet and Private Sector During Cancer Moonshot Week of Action, White House (Dec. 8, 2022) [hereinafter White House Fact Sheet], https://www.whitehouse.gov/ostp/news-updates/2022/12/08/fact-sheet-white-house-details-progress-from-the-cancer-cabinet-and-private-sector-during-cancer-moonshot-week-of-action/ [https://perma.cc/4XHF-RG2G].
32 Robert A. Bonacci et al., Toward Greater Pre-Exposure Prophylaxis Equity: Increasing Provision and Uptake for Black and Hispanic/Latino Individuals in the U.S., 61 Am. J. Preventive Med. (Special Article) S60, S62-65.
33 Katherine Keisler-Starkey et al., U.S. Census Bureau, P60-281, Health Insurance Coverage in the United States: 2022, at 1, 2 (2023), https://www.census.gov/content/dam/Census/library/publications/2023/demo/p60-281.pdf [https://perma.cc/3WP6-SPPS].
34 Id. at 12, 13 fig.8.
35 Id. at 11 fig.7 (reporting 28.7% of adults below 100% of poverty level and 62.8% of adults between 100% and 399% of poverty level with private insurance).
36 The preventive services mandate also impacts adults enrolled in Medicaid through Medicaid expansion, since these individuals are guaranteed access to essential health benefits, which includes preventive services. See Patient Protection and Affordable Care Act, Pub. L. No. 111-148, § 2001(a)(1), (c)(3), 124 Stat. 119, 271, 277 (codified as amended at 42 U.S.C. § 18001); see also 45 CFR §§ 147.130(a), 156.115(a)(4) (2024) (defining essential health benefits to include preventive services). While the potential impact of Braidwood on Medicaid enrollees is murkier, it suffices to say here that any impact on Medicaid enrollees would further hinder efforts to address health disparities.
37 USPSTF: Who We Are & How We Work, U.S. Preventive Servs. Task Force 2 (2022), https://www.uspreventiveservicestaskforce.org/uspstf/sites/default/files/inline-files/uspstf-who-we-are-how-we-work-2022.pdf [https://perma.cc/L3RD-LJA2].
38 U.S. Preventive Servs. Task Force, Actions to Transform the US Preventive Services Task Force Methods to Mitigate Systemic Racism in Clinical Preventive Services, 326 JAMA 2405, 2405 (2021) [https://perma.cc/5F9Y-75HR].
39 Aparna Soni et al., How Have ACA Insurance Expansions Affected Health Outcomes? Findings from the Literature, 39 Health Affs. 371, 375 (2020) (“[S]ome types of medical care, such as preventive care and chronic disease management, may take longer to improve health.”).
40 42 U.S.C. § 299b-4(a)(6).
41 Braidwood Mgmt. v. Becerra, 627 F. Supp. 3d 624, 655 (N.D. Tex. 2022); Braidwood Mgmt. v. Becerra, 666 F. Supp. 3d 613, 633 (N.D. Tex., 2023).
42 Braidwood Mgmt., 627 F. Supp. 3d at 645-46.
43 Id.
44 See Opening Brief for the Federal Defendants at 17-18, Braidwood Mgmt. v. Becerra, 666 F. Supp. 3d 613 (N.D. Tex. 2023) (No. 23-10326).
45 Id. at 35, 39.
46 About the U.S. Preventive Services Task Force: Our Members, U.S. Preventive Servs. Task Force, https://www.uspreventiveservicestaskforce.org/uspstf/index.php/about-uspstf/current-members [https://perma.cc/RWF3-4G7C].
47 Id.; Nominate a New U.S. Preventive Services Task Force Member, Agency for Healthcare Rsch. & Quality, https://www.ahrq.gov/cpi/about/otherwebsites/uspstf/nominate.html [https://perma.cc/9FU9-QUAD].
48 42 U.S.C. § 299b-4(a)(2)(F) (2022).
49 Michael J. Barry et al., Putting Evidence into Practice: An Update on the US Preventive Services Task Force Methods for Developing Recommendations for Preventive Services, 21 Annals Fam. Med. 165, 165 (2023).
50 Id. at 166.
51 USPSTF Recommendations Development Process, U.S. Preventive Servs. Task Force (May 2021), https://www.uspreventiveservicestaskforce.org/uspstf/about-uspstf/task-force-resources/uspstf-recommendations-development-process [https://perma.cc/7RR9-SC9V].
52 Id.
53 Id.
54 Id.
55 Id.
56 Barry et al., supra note 49, at 166.
57 USPSTF: The Primary Care Clinician’s Source for Prevention Recommendations, U.S. Preventive Servs. Task Force (May 2021), https://www.uspreventiveservicestaskforce.org/uspstf/about-uspstf/task-force-resources/primary-care-clinicans-source-factsheet [https://perma.cc/69CP-KFB2]; USPSTF Recommendations Development Process, supra note 51.
58 U.S. Preventive Servs. Task Force, supra note 38, at 2405.
59 Id. at 2407-08. Other federal agencies have also recognized the challenge of addressing health inequities when research involving diverse subjects is limited and are taking steps to try to address this. For example, the NIH and the FDA are also including the requirement of diversity in the studies they fund and use to address systemic racism and improve health equity. See Richardae Araojo et al., FDA Addresses Health Disparities Through Communication, Research, and Collaboration, U.S. Food & Drug Admin.: FDA Voices, https://www.fda.gov/news-events/fda-voices/fda-addresses-health-disparities-through-communication-research-and-collaboration (last reviewed Apr. 30, 2019); Kathy Etz et al., Minority Health and Health Disparities Research: Running the Marathon, Maintaining the Momentum, Nat’l Inst. Health (Sept. 12, 2023), https://www.nih.gov/ending-structural-racism/minority-health-health-disparities-research-running-marathon-maintaining-momentum [https://perma.cc/4TLP-RJXH].
60 U.S. Preventive Servs. Task Force, supra note 38, at 2409.
61 Id. at 2407.
62 See Jennifer Lin et al., U.S. Preventive Servs. Task Force, Agency for Healthcare Rsch. & Quality, No. 23-05311-EF-1, Health Equity Framework for the U.S. Preventive Services Task Force 6 (2023), https://www.uspreventiveservicestaskforce.org/uspstf/sites/default/files/2023-12/health-equity-framework-report.pdf [https://perma.cc/2A29-LZNN].
63 See, e.g., Michael J. Rovito et al., A Call to Action to Review the USPSTF’s Recommendation for Testicular Self-Examination, Am. J. Men’s Health, Sept. 2022, at 4 (calling for USPSTF to review its testicular cancer self-examination recommendation and to take other action, including reviewing their methods for making recommendations); Andrew T. Chan, Aspirin and the USPSTF—What About Cancer?, 8 JAMA Oncology 1393, 1393 (2022) (criticizing USPSTF’s reversal on the use of aspirin to prevent colorectal cancer as insufficiently nuanced).
64 Press Release, U.S. Rep. Anna G. Eshoo, Eshoo & Pallone Urge HHS to Reevaluate USPSTF Processes to Better Serve Health Care Needs (July 13, 2022), https://eshoo.house.gov/media/press-releases/eshoo-pallone-urge-hhs-reevaluate-uspstf-processes-better-serve-health-care [https://perma.cc/7K3Y-HM4Y].
65 ACR/SBI Statement on New USPSTF Breast Cancer Screening Recommendations, Am. Coll. Radiology (May 9, 2023), https://www.acr.org/Media-Center/ACR-News-Releases/2023/ACR-SBI-Statement-on-New-USPSTF-Breast-Cancer-Screening-Recommendations [https://perma.cc/ACW5-A222].
66 See U.S. Preventive Servs. Task Force, supra note 38, at 2409.
67 Braidwood Mgmt. v. Becerra, 666 F. Supp. 3d 613, 614 (N.D. Tex. 2023).
68 Cancer Facts & Figures 2022, Am. Cancer Soc’y 4 (2022), https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2022/2022-cancer-facts-and-figures.pdf [https://perma.cc/2GCB-CKEF].
69 Id.
70 A & B Recommendations, U.S. Preventive Servs. Task Force, https://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics/uspstf-a-and-b-recommendations [https://perma.cc/NN9X-AZXX].
71 See id.
72 White House Fact Sheet, supra note 31.
73 Compare Final Recommendation Statement Colorectal Cancer: Screening, U.S. Preventive Servs. Task Force (Jan. 1, 1996), https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening-1996 [https://perma.cc/D6TJ-E8EP], with Final Recommendation Statement Colorectal Cancer: Screening, U.S. Preventive Servs. Task Force (May 18, 2021) [hereinafter 2021 Colorectal Cancer Recommendation Statement], https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening [https://perma.cc/43SF-9SMZ].
74 See Rebecca L. Siegel et al., Colorectal Cancer Statistics, 2023, 73 CA: Cancer J. for Clinicians 233, 236 (2023).
75 Id. at 244.
76 Compare Final Recommendation Statement Colorectal Cancer: Screening, U.S. Preventive Servs. Task Force (Oct. 15, 2008), https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening-2008 [https://perma.cc/ KN2H-RQM9] (recommendations before the March 2010 effective date of the ACA preventive care mandate), with 2021 Colorectal Cancer Recommendation Statement, supra note 73 (recommendations after the March 2010 effective date of the ACA preventive care mandate).
77 2021 Colorectal Cancer Recommendation Statement, supra note 73.
78 A. Mark Fendrick & Nicholas Bagley, Michigan Professors Offer Insights into What Braidwood Ruling Could Mean for Preventive Screening in Cancer Care, 28 Am. J. Managed Care SP353, SP354 (2023).
79 Recommendation Statement Colorectal Cancer: 2021, supra note 73.
80 See Jaspreet Shergill et al., Fecal Immunochemical Test (FIT) Versus Colonoscopy: Does Knowing That a Positive FIT Requires a Follow-Up Colonoscopy Affect Initial Decision Making in the US?, 27 Preventive Med. Reps. 1, 3 (2022).
81 Stool DNA testing can range from $581 to $681, depending on whether you are willing to pay for the entire test upfront (in which case you can get a $100 discount). Fecal immunochemical tests range between $25 and $89 depending on the manufacturer. See Monique M. Johnson, Does Insurance Cover At-Home Colon Cancer Screening Tests?, GoodRx Health (Mar. 23, 2022), https://www.goodrx.com/conditions/colon-cancer/at-home-colon-cancer-test. It is important to note, however, that for patients who choose to get an at-home screening test, if their test comes back positive, they will need to get a colonoscopy. This colonoscopy will no longer be considered screening and instead will be considered diagnostic, and hence potentially subject to cost-sharing. See Danielle Underferth, Colorectal Cancer and Race: What Black Men and Women Need to Know, MD Anderson Cancer Ctr. (Dec. 14, 2020), https://www.mdanderson.org/cancerwise/colorectal-cancer-and-race--what-black-men-and-women-need-to-know.h00-159387468.html [https://perma.cc/9STQ-B89K].
82 John M. Carethers, Racial and Ethnic Disparities in Colorectal Cancer Incidence and Mortality, 151 Advances Cancer Rsch. 197, 226 (2022).
83 Dan Lea, Health Disparities in Preventive Screenings for African Americans, Mayo Clinic News Network, (Feb. 3, 2023), https://newsnetwork.mayoclinic.org/discussion/health-disparities-in-preventive-screenings-for-african-americans/ [https://perma.cc/GP8F-7MAN].
84 2021 Colorectal Cancer Recommendation Statement, supra note 73.
85 Michael Masciadrelli, Why Are Colorectal Cancer Rates Rising Among Younger Adults?, Yale Sch. Med. (Mar. 29, 2023), https://medicine.yale.edu/news-article/with-colorectal-cancer-rates-rising-among-younger-adults-a-yale-cancer-center-expert-explains-there-may-be-more-factors-behind-this-worrisome-trend/ [https://perma.cc/XWQ9-JD7J].
86 Charles Muller et al., Disparities in Early-Onset Colorectal Cancer, Cells, 2021, at 1, 1018, 1018 (2021), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8146231/pdf/cells-10-01018.pdf [https://perma.cc/4ZCP-VNLW].
87 Eric M. Montminy et al., Shift in the Proportion of Distant Stage Early-Onset Colorectal Adenocarcinoma in the United States, 31 Cancer Epidemiology, Biomarkers & Prevention 334, 335-337 (2022).
88 Alex H. Krist et al., Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement, 325 JAMA 962, 962-63 (2021).
89 Id.
90 State of Lung Cancer: Lung Cancer Key Findings, Am. Lung Ass’n, https://www.lung.org/research/state-of-lung-cancer/key-findings [https://perma.cc/E7E3-QLUF]; see Sean Blandin Knight et al., Progress and Prospects of Early Detection in Lung Cancer, Open Biology, July 27, 2017, at passim (2017).
91 State of Lung Cancer: Lung Cancer Key Findings, supra note 90.
92 State of Lung Cancer: Racial and Ethnic Disparities, Am. Lung Ass’n, https://www.lung.org/research/state-of-lung-cancer/racial-and-ethnic-disparities [https://perma.cc/V65B-UZ4S].
93 Id.
94 Lisa L. Dwyer et al., Disparities in Lung Cancer: A Targeted Literature Review Examining Lung Cancer Screening, Diagnosis, Treatment, and Survival Outcomes in the United States, J. Racial & Ethnic Health Disparities, May 19, 2023, at 4.
95 Christopher A. Haiman et al., Ethnic and Racial Differences in the Smoking-Related Risk of Lung Cancer, 354 New Eng. J. Med. 333, 341 (2006).
96 Lung Cancer: Screening, U.S. Preventive Servs. Task Force (Dec. 31, 2013), https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/lung-cancer-screening-december-2013 [https://perma.cc/SVW7-HDYD].
97 Id.
98 See CT Test for Hidden Lung Cancer Is Cost-Effective but Not Covered for Many Likely to Benefit, Harv. Health Publ’g: Harv. Health Blog (Nov. 6, 2014), https://www.health.harvard.edu/blog/ct-tests-hidden-lung-cancer-cost-effective-covered-many-likely-benefit-201411067506 [https://perma.cc/68LU-KZMN] (discussing the Center for Medicare & Medicaid Services’ decision, as of 2014, not to cover lung cancer screening).
99 Virginia A. Moyer, U.S. Preventive Servs. Task Force, Screening for Lung Cancer: U.S. Preventive Services Task Force Recommendation Statement, 160 Annals Int. Med. 330, 330 (2014).
100 Lung Cancer: Screening, U.S. Preventive Servs. Task Force (Mar. 9, 2021), https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/lung-cancer-screening [https://perma.cc/B48T-GCNG].
101 Krist, supra note 88, at 964.
102 Id.
103 Compare Tobacco Smoking Cessation in Adults, Including Pregnant Women: Behavioral and Pharmacotherapy Interventions, U.S. Preventive Servs. Task Force (Sept. 21, 2015), https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/tobacco-use-in-adults-and-pregnant-women-counseling-and-interventions-september-2015 [https://perma.cc/FPZ2-ZFU2], with Tobacco Use in Adults and Pregnant Women: Counseling and Interventions, U.S. Preventive Servs. Task Force (Apr. 15, 2009), https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/tobacco-use-in-adults-and-pregnant-women-counseling-and-interventions-2009 [https://perma.cc/Z2YA-LT9M].
104 Jamie Hartmann-Boyce et al., Nicotine Replacement Therapy Versus Control for Smoking Cessation, Cochrane Database Systematic Revs., May 31, 2018, at 1.
105 Key Statistics for Cervical Cancer, Am. Cancer Soc’y (Aug. 23, 2023), https://www.cancer.org/content/dam/CRC/PDF/Public/8599.00.pdf [https://perma.cc/GU98-5JLY]. People of other gender identities can get cervical cancer, such as transgender men, non-binary people, and other persons assigned female at birth, as the USPSTF’s 2018 cervical cancer screening recommendation implicitly recognizes. See U.S. Preventive Servs. Task Force, Screening for Cervical Cancer: US Preventive Services Task Force Recommendation Statement, 320 JAMA 674, 675 (2018) (“This recommendation statement applies to all asymptomatic individuals with a cervix.”) However, because the literature, including that of the USPSTF, predominantly discusses cervical cancer using the term “women,” and some sources address cervical cancer in the context of women’s health, this Article will refer to cervical cancer among persons described as “women.”
106 Screening Leads to Cervical Cancer Decline in the United States, Am. Cancer Soc’y Cancer Action Network (Jan. 2020), https://www.fightcancer.org/sites/default/files/FINAL%20-%20Cervical%20Cancer%20General%20Factsheet%2001.08.20.pdf [https://perma.cc/RVM3-873B].
107 Cervical Cancer Prognosis and Survival Rates, Nat’l Inst. Health (Apr. 27, 2023), https://www.cancer.gov/types/cervical/survival [https://perma.cc/3393-J3HM].
108 Health and Economic Benefits of Cervical Cancer Interventions, Ctrs. for Disease Control & Prevention (Dec. 21, 2022), https://www.cdc.gov/chronicdisease/programs-impact/pop/cervical-cancer.htm [https://perma.cc/ZLR9-U4SX].
109 Final Recommendation Statement: Cervical Cancer: Screening, U.S. Preventive Servs. Task Force (Jan. 7, 2003), https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/cervical-cancer-screening-2003 [https://perma.cc/L83G-2Y6Q].
110 Final Recommendation Statement: Cervical Cancer: Screening, U.S. Preventive Servs. Task Force (Mar. 15, 2012), https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/cervical-cancer-screening-2012 [https://perma.cc/E8HV-5PPA].
111 U.S. Preventive Servs. Task Force, Screening for Cervical Cancer: US Preventive Services Task Force Recommendation Statement, 320 JAMA 674, 675 (2018).
112 Id. at 676-79, 81 (recognizing that there is a balance of risks and benefits with the use of cotesting because it has the highest rate of false positives, but that rate falls for women older than 30).
113 Jennifer C. Spencer et al., Racial and Ethnic Disparities in Cervical Cancer Screening from Three U.S. Healthcare Settings, 65 Am. J. Preventive Med. 667, 668 (2023); see also Am. Cancer Soc’y, Cancer Facts & Figures for African American/ Black People 2022-2024, at 21 (2022), https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/cancer-facts-and-figures-for-african-americans/2022-2024-cff-aa.pdf [https://perma.cc/6QBJ-ASF3].
114 Am. Cancer Soc’y, supra note 113, at 21.
115 Spencer et al., supra note 113, at 668.
116 See id. at 668, 674; Am. Cancer Soc’y, supra note 113, at 14, 21.
117 Draft Research Plan, Cervical Cancer: Screening, U.S. Preventive Servs. Task Force (Oct. 28, 2021), https://www.uspreventiveservicestaskforce.org/uspstf/document/draft-research-plan/cervical-cancer-screening-adults-adolescents [https://perma.cc/YZJ4-XX3N].
118 Id.
119 Id.
120 Women’s Preventive Services Guidelines, Health Res. & Servs. Admin., https://www.hrsa.gov/womens-guidelines [https://perma.cc/3Z37-797D].
121 Compare id. with U.S. Preventive Servs. Task Force, supra note 111, at 63.
122 Braidwood Mgmt. v. Becerra, 627 F. Supp. 3d 624, 640, 655 (N.D. Tex. 2022).
123 See Brief of Appellees/Cross-Appellants at 57-60, Braidwood Mgmt. v. Becerra, 666 F. Supp. 3d 613 (N.D. Tex., 2023) (No. 23-10326).
124 Breast Cancer: Medications to Reduce Risk, U.S. Preventive Servs. Task Force (Sept. 15, 2013), https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-medications-for-risk-reduction-2013 [https://perma.cc/B2JE-RLJS].
125 BRCA-Related Cancer Risk Assessment, Genetic Counseling, and Genetic Testing, U.S. Preventive Servs. Task Force (Dec. 24, 2013), https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/brca-related-cancer-risk-assessment-genetic-counseling-and-genetic-testing-2013 [https://perma.cc/JN8B-P3QU].
126 U.S. Preventive Servs. Task Force, Risk Assessment, Genetic Counseling, and Genetic Testing for BRCA-Related Cancer: US Preventive Services Task Force Recommendation, 322 JAMA 652, 660 (2019) [hereinafter 2019 BRCA Risk Assessment Recommendation]. As with cervical cancer, people with gender identities other than women can be at risk for breast cancer. The USPSTF began to recognize this in its 2019 changes to the BRCA Risk Assessment Recommendation, which included the following language: “While this recommendation applies to women, the net benefit estimates are driven by biological sex (ie, male/female) rather than gender identity. Persons should consider their sex at birth to determine which recommendation best applies to them.” Id. For the reasons discussed in footnote 105, supra, this Article uses the terminology “women” in its subsequent discussion of breast cancer except where otherwise noted.
127 Final Recommendation Statement: Breast Cancer: Screening, U.S. Preventive Servs. Task Force (Apr. 30, 2024), https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-screening#bcei-recommendation-title-area [https://perma.cc/P5W8-EJSM] [hereinafter 2024 Final Breast Cancer Screening Recommendation].
128 2019 BRCA Risk Assessment Recommendation, supra note 126, at 653.
129 BRCA Gene Mutations, Ctrs. for Disease Control & Prevention, https://www.cdc.gov/cancer/breast/young_women/bringyourbrave/hereditary_breast_cancer/brca_gene_mutations [https://perma.cc/LS4A-LX7D].
130 See Genetic Testing for Breast Cancer, Breastcancer.org (Nov. 9, 2023, 1:56 PM), https://www.breastcancer.org/genetic-testing [https://perma.cc/D9DU-HQUT] (stating that the cost of genetic testing “can range from $300 to $5,000, depending on the type of test[ing]”).
131 2019 BRCA Risk Assessment Recommendation, supra note 126, at 656.
132 Am. Cancer Soc’y, supra note 113, at 14-15.
133 U.S. Preventive Servs. Task Force, Understanding Task Force Draft Recommendations: Screening for Breast Cancer 2 (2023), https://www.uspreventiveservicestaskforce.org/files/breast-cancer/Breast_Cancer_DRS_Consumer_Guide.pdf [https://perma.cc/MFA7-VEB5].
134 Amy Trentham-Dietz et al., Breast Cancer Working Group, Cancer Intervention & Surveillance Modeling Network, Breast Cancer Screening with Mammography: An Updated Decision Analysis for the U.S. Preventive Services Task Force 38 (2023), https://uspreventiveservicestaskforce.org/home/getfilebytoken/uRwAnYAnc4HCNY3j3h5v_z [https://perma.cc/K7HW-UZAM].
135 2024 Final Breast Cancer Screening Recommendation, supra note 127. The 2024 final recommendation for breast cancer statement also shifted its language to describe the target population as “cisgender women and all other persons assigned female at birth (including transgender men and nonbinary persons) 40 years or older at average risk of breast cancer.” Id. Prior to this recommendation, the 2016 recommendation described the target population as “asymptomatic women aged 40 years or older.” Albert L. Siu, U.S. Preventive Servs. Task Force, Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement, 164 Annals Internal Med. 279, 279 (2016). This shift, which is more explicit than the language in the 2019 BRCA Risk Assessment Recommendation, see supra note 126, also reflects a move toward equity, in that it will help facilitate access to appropriate breast cancer screening for people who are at risk for breast cancer due to their sex at birth, but who do not identify as women.
136 See Breast Cancer Screening and Early Detection, Susan G. Komen Found., https://www.komen.org/breast-cancer/screening/ [https://perma.cc/GB3Y-Y7MA].
137 Wendie A. Berg et al., Screening Algorithms in Dense Breast: AJR Expert Panel Narrative Review, 216 Am. J. Roentgenology 275, 276 (2021).
138 Anne Marie McCarthy et al., Racial Differences in Quantitative Measures of Area and Volumetric Breast Density, 108 J. Nat’l Cancer Inst., Apr. 29, 2016, at 5.
139 See Trentham-Dietz et al., supra note 134, at 18.
140 See Draft Recommendation Statement: Breast Cancer: Screening, U.S. Preventive Servs. Task Force (May 9, 2023), https://www.uspreventiveservicestaskforce.org/uspstf/document/RecommendationStatementDraft/breast-cancer-screening [https://perma.cc/MS6S-QF4V];; Carol M. Mangione, What Our Patients with Dense Breasts Deserve to Know, Medpage Today (May 25, 2023), https://www.medpagetoday.com/opinion/second-opinions/104695 [https://perma.cc/D284-JZTS].
141 2024 Final Breast Cancer Screening Recommendation, supra note 127.
142 See id.
143 Id.
144 U.S. Statistics, HIV.gov (Dec. 7, 2023), https://www.hiv.gov/hiv-basics/overview/data-and-trends/statistics/ [https://perma.cc/ZL5T-QVMK]; The HIV/AIDS Epidemic in the United States: The Basics, KFF (June 7, 2021), https://www.kff.org/hivaids/fact-sheet/the-hivaids-epidemic-in-the-united-states-the-basics/ [https://perma.cc/M59P-V7E5].
145 U.S. Statistics, supra note 144.
146 Id.
147 Id.
148 Id.
149 HIV/AIDS and African Americans, Dep’t of Health & Hum. Servs., Off. of Minority Health, https://minorityhealth.hhs.gov/hivaids-and-african-americans [https://perma.cc/FPV5-HALT]; AtlasPlus Tables, Nat’l Ctr. for HIV, Viral Hepatitis, STD, & TB Prevention, Ctrs. for Disease Control & Prevention, https://gis.cdc.gov/grasp/nchhstpatlas/tables.html [https://perma.cc/57SX-Q342] (check “AIDS Deaths” in the indicator step; check “National” from the geography step; check “2021” in the year step; check “ages 13 years and older,” “Black/African American,” and “White” in the demographic step; then click “Create my Table”) (stating rate of death due to AIDS was higher in 2021 for African Americans as compared to white Americans ages 13 or older).
150 Press Release, Nat’l. Ctr. for HIV, Viral Hepatitis, STD, & TB Prevention, Ctrs. for Disease Control & Prevention, HIV Declines Among Young People and Drives Overall Decrease in New HIV Infections (May 23, 2023), https://www.cdc.gov/nchhstp/newsroom/2023/2021-hiv-incidence.html [https://perma.cc/YF3Z-3VJX].
151 PrEP for HIV Prevention in the U.S., Nat’l. Ctr. for HIV, Viral Hepatitis, STD, & TB Prevention, Ctrs. for Disease Control & Prevention, https://www.cdc.gov/nchhstp/newsroom/fact-sheets/hiv/PrEP-for-hiv-prevention-in-the-US-factsheet.html [https://perma.cc/M72Y-P8NW] (last reviewed Sept. 29, 2023).
152 Pre-Exposure Prophylaxis (PrEP), Ctrs. for Disease Control & Prevention, https://www.cdc.gov/hiv/risk/prep/index.html [https://perma.cc/CT2Q-VNWM].
153 AIDSVu Releases New Data Showing Significant Inequities in PrEP Use Among Black and Hispanic Americans, AIDSVu (July 29, 2022), https://aidsvu.org/prep-use-race-ethnicity-launch-22/ [https://perma.cc/FS5X-BRTG].
154 About PrEP, Ctrs. for Disease Control & Prevention, https://www.cdc.gov/hiv/basics/prep/about-prep.html [https://perma.cc/G5WY-WU2L] (last reviewed June 30, 2022).
155 See U.S. Pub. Health Serv., Ctrs. for Disease Control & Prevention, Preexposure Prophylaxis for the Prevention of HIV Infection in the United States – 2021 Update: Clinical Practice Guideline 28 (2021), https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2021.pdf [https://perma.cc/CHY3-8C8Z]; see also U.S. Dep’t of Lab., FAQs About Affordable Care Act Implementation Part 47, at 3-4 (2021), https://www.dol.gov/sites/dolgov/files/EBSA/about-ebsa/our-activities/resource-center/faqs/aca-part-47.pdf [https://perma.cc/F2L4-F38K] (clarifying that for purposes of the USPSTF’s PrEP coverage recommendation, PrEP includes a suite of baseline and monitoring services).
156 See Ctrs. for Disease Control & Prevention , supra note 155, at 28-34.
157 Whitney Sewell et al., Brief Report: “I Didn’t Really Have a Primary Care Provider Until I Got PrEP”: Patients’ Perspectives on HIV Preexposure Prophylaxis as a Gateway to Health Care, 88 J. Acquired Immune Deficiency Syndromes 31, 34 (2021); Julia L. Marcus et al., HIV Preexposure Prophylaxis as a Gateway to Primary Care, 108 Am. J. Pub. Health 1418, 1419 (2018).
158 What is Ending the HIV Epidemic in the U.S.?, HIV.gov (Dec. 4, 2023), https://www.hiv.gov/federal-response/ending-the-hiv-epidemic/overview/ [https://perma.cc/9XZX-RJN7]; Expanding the Reach of Pre-Exposure Prophylaxis to End the HIV Epidemic, CAREAction Newsl. (Ryan White HIV/AIDS Program, Health Res. Servs. Admin., Rockville, MD), Sept. 2020, https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/resources/careaction-prep-newsletter.pdf [https://perma.cc/R8S2-E7AH].
159 Expanding the Reach of Pre-Exposure Prophylaxis to End the HIV Epidemic, supra note 158.
160 Sarah Varney, HIV Preventive Care Is Supposed to Be Free in the U.S. So, Why Are Some Patients Still Paying?, KFF Health News (Mar 3, 2022), https://kffhealthnews.org/news/article/prep-hiv-prevention-costs-covered-problems-insurance [https://perma.cc/BSC7-9WAN]; Amy Killelea et al., Financing and Delivering Pre-Exposure Prophylaxis (PrEP) to End the HIV Epidemic, 50 J.L. Med. & Ethics 8, 10 (2022).
161 Varney, supra note 160.
162 U.S. Preventive Servs. Task Force, Preexposure Prophylaxis for the Prevention of HIV Infection: US Preventive Services Task Force Recommendation Statement, 321 JAMA 2203, 2204 (2019).
163 Cf. Final Recommendation Statement: Prevention of Human Immunodeficiency Virus (HIV) Infection: Screening, U.S. Preventive Servs. Task Force (June 11, 2019), https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/human-immunodeficiency-virus-hiv-infection-screening [https://perma.cc/CD4H-TKQT] (for comparison, USPSTF has taken 6 to 9 years between issuing each of its updates on HIV screening).
164 U.S. Preventive Servs. Task Force, Preexposure Prophylaxis to Prevent Acquisition of HIV: US Preventive Services Task Force Recommendation Statement, 330 JAMA 736, 738 (2023).
165 See U.S. Dep’t. of Lab., supra note 155, at 3.
166 See AIDSVu, Deeper Look: PrEP, https://aidsvu.org/resources/deeper-look-prep/ [hereinafter Deeper Look: PrEP] [https://perma.cc/YP4V-LEEK].
167 Robert A. Bonacci et al., Estimated Uncovered Costs for HIV Preexposure Prophylaxis in the US, 2018, 42 Health Affs. 546, 546, 551-52 (2023).
168 Lorraine T. Dean et al., Estimating the Impact of Out-of-Pocket Cost Changes on Abandonment of HIV Pre-Exposure Prophylaxis, 43 Health Affs. 36, 39 (2024).
169 Id. at 40-41.
170 Id. at 43.
171 Id. at 42.
172 A. David Paltiel et al., Increased HIV Transmissions with Reduced Insurance Coverage for HIV Preexposure Prophylaxis: Potential Consequences of Braidwood Management v. Becerra, Open F. Infectious Diseases, Mar. 2023, at 2.
173 Id. at 3.
174 See Deeper Look: PrEP, supra note 166. As more White people have been able to access PrEP, inequity in access has grown, as reflected in PrEP-to-Need Ratios (the number of PrEP users compared to the number of new HIV diagnoses, this measurement helps assess whether PrEP use is preventing new HIV infections) that are growing faster for White people than for Black or Hispanic people. See id. However, this statistic, rather than being an argument against no-cost PrEP, further reveals the need to remove other barriers to PrEP access, such as the Medicaid coverage gap, as discussed in the text infra.
175 Jessica Bartlett, Despite Federal Rules, HIV Prevention Drug Still Comes with Costs, Bos. Globe (Jan. 8, 2023, 4:58 PM), https://www.bostonglobe.com/2023/01/08/metro/despite-federal-rules-hiv-prevention-drug-still-comes-with-costs/ [https://perma.cc/Y5WP-2VY7].
176 See U.S. Preventive Servs. Task Force, Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: US Preventive Services Task Force Recommendation, 328 JAMA 746, 748 (2022) (noting that Black adults have the highest rate of cardiovascular disease and the lowest use of statins).
177 See U.S. Preventive Servs. Task Force, Aspirin Use to Prevent Preeclampsia and Related Morbidity and Mortality, US Preventive Services Task Force Recommendation Statement, 326 JAMA 1186, 1186, 1190 (2021) (noting that the rate of maternal death is higher among Black and Hispanic women, and that there is a lack of research cohorts that include women who are at the highest risk for preeclampsia namely Black and Hispanic women).
178 See Preventive Services Impacted by Braidwood v. Becerra, Am. Lung Ass’n (June 23, 2023), https://www.lung.org/getmedia/7ee72d9c-ee78-4a77-a419-9bfa87e69acd/Braidwood-Preventive-Services-Chart.pdf [https://perma.cc/5LE6-MLCB] (identifying a range of conditions with USPSTF recommendations post-March 2010, such that their coverage may be impacted if Braidwood is affirmed).