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Susan G. Komen® Awaits Outcome in Braidwood Management, Inc. et al. v. Xavier Becerra et al.

This case has the potential to reverse over a decade of work to improve access to preventive services

Today, oral argument was heard in the Fifth Circuit Court of Appeals on Braidwood Management, Inc. et al. v. Xavier Becerra et al., a case that could impact millions of Americans access to breast cancer screening and services.

As a reminder, the plaintiffs (Braidwood Management, Inc.) argue that the Affordable Care Act’s preventive services requirement is unconstitutional because it violates the Appointments Clause, the nondelegation doctrine, and the Religious Freedom Restoration Act. The federal district court in Texas agreed with the plaintiffs. The defendants appealed the decision to the Fifth Circuit, where the case is currently pending.

The preventive services requirement has been in effect since 2010 and extends coverage of evidence-based preventive services (such as cancer screening, tobacco cessation, contraception, and immunizations), without cost-sharing, to more than 150 million people each year. That guaranteed benefit could go away if the Fifth Circuit upholds the district court’s decision.

Specific to breast cancer, the preventive services benefit requires insurers to cover mammography screenings every 2 years for women 50 and over, and as recommended by a provider for women 40 to 49 or women at higher risk for breast cancer. Additionally, plans must cover a risk assessment to individuals with ancestry associated with breast cancer susceptibility 1 and 2 (BRCA1/2) gene mutations, and, for those with a positive result, genetic counseling, and testing. Finally, insurers must fully cover risk-reducing medications, such as tamoxifen, raloxifene, or aromatase inhibitors, to women who are at increased risk for breast cancer and at low risk for adverse medication effects.

As the Braidwood case continues its way through the legal process, Komen emphasizes the importance of these preventive services for the breast cancer community.

Susan G. Komen filed an amicus brief (or “friend of the court” brief) in support of the defendants in the Braidwood appeallast year, highlighting the very positive impact that access to these services with no cost-sharing has had for the breast cancer community. Echoing statements made in the amicus brief, Komen urges the Court to understand the consequences of the district court’s decision striking these coverage requirements. Since limiting the preventive care to which individuals have access increases the risk of breast cancer progressing to more advanced stages; treatment costs; and the risk of breast-cancer-related deaths, Komen respectfully requests that the Court reverse the district court’s judgment.

We will be watching the case closely and will provide relevant information to our community.