The Supreme Court will determine the future of free preventative care

Summary

Marketplace Morning Report: The Supreme Court's Crucial Decision on Preventive Care

Release Date: April 18, 2025 | Host: David Brancaccio

In this episode of Marketplace Morning Report, host David Brancaccio delves into a pivotal issue poised to reshape the landscape of American healthcare: the U.S. Supreme Court's impending decision on the Affordable Care Act (ACA) and its mandate requiring insurance companies to cover preventive services without out-of-pocket costs. This comprehensive summary breaks down the episode's key discussions, insights, and conclusions, providing a thorough overview for those who haven't tuned in.

---

1. Introduction to the Supreme Court Challenge

David Brancaccio opens the discussion by highlighting a critical legal battle that could redefine preventive healthcare in the United States.

"Is it right that insurance companies have to pay the whole bill to check a person for, say, diabetes or cancer?" (00:01)

He explains that the ACA currently mandates insurers to cover the entire costs of certain preventive screenings. However, this mandate is now under threat as the Supreme Court is set to rule on a challenge brought forth by two Texas businesses. This marks the fourth time the justices are addressing issues related to the ACA, with the outcome anticipated later this year.

---

2. The Impact on Medical Practice and Patient Care

Alex Olgan provides an in-depth report featuring insights from healthcare professionals about the real-world implications of the ACA's preventive care provisions.

Alison Ruff, a primary care doctor at the University of Michigan, underscores the importance of preventive screenings in her practice.

"I spent three years probably convincing this one male patient in his 60s to get his colonoscopy." (00:43)

She recounts a success story where timely intervention through a colonoscopy saved a patient's life by removing a precancerous growth.

"He was totally overwhelmed. He was like, thank you, doc. They were able to remove it completely. I don't have cancer. But if we'd waited another year, it would have been a very different conversation." (00:56)

Since the ACA's implementation in 2010, there has been a notable increase in screenings for colon cancer, chronic diseases, and vaccinations, largely attributed to mandatory insurer coverage.

---

3. Value-Based Insurance Design and Its Importance

The episode introduces the concept of Value-Based Insurance Design (VBID), pioneered by Dr. Mark Fendrick of the University of Michigan.

"High value things should be cheap and low value things should be expensive." (01:19)

Fendrick explains that VBID aims to align patient costs with the value of services, encouraging the use of high-benefit preventive measures by keeping them affordable.

"And one of the great things about it is it's a gift that keeps on giving." (01:44)

An independent panel of medical experts annually updates the list of preventive services covered without cost-sharing, ensuring that patients have access to essential screenings and vaccinations.

---

4. Legal Challenges and Potential Repercussions

The core of the episode revolves around the legal challenges posed by two Texas businesses against the ACA's preventive care mandate.

Alex Olgan reports that these businesses argue the mandate infringes upon their religious beliefs and that the independent panel determining free preventive services was improperly selected.

Dr. Mark Fendrick voices his concerns about the potential rollback of a decade-long public health advancement.

"This is something that I advocated for many years and most importantly, actually saw the impressive impact on patient behavior." (02:14)

He fears that overturning the mandate would lead to a regression in public health, undoing the progress made in encouraging preventive care.

Zach Barron, director of the Center for Health Policy and the Law at Georgetown, emphasizes the broader implications of the case.

"At the end of the day, what this case is about is whether insurers and employers can sort of go back to this wild west that we had before the Affordable Care Act was signed into law." (02:40)

The decision could determine whether the U.S. returns to pre-ACA conditions regarding standardized coverage for preventive services.

---

5. Business Perspectives and Future Outlook

Despite the ongoing legal battle, many businesses remain committed to covering preventive care, recognizing its long-term cost-saving benefits.

Alex Olgan notes that:

"Even if the mandate does go away, most businesses say they plan to keep paying for this care anyways, in part because it saves money long term." (02:52)

This commitment suggests a potential de facto continuation of preventive care coverage regardless of the Supreme Court's ruling, driven by both ethical considerations and economic incentives.

---

6. Additional News Highlights

Beyond the primary focus on healthcare, the episode briefly touches upon other significant news:

• Ukraine's Memorandum with the U.S.: Ukraine has signed a memorandum to sell minerals and collaborate on energy infrastructure with the United States. However, the deal lacks concrete security guarantees, raising concerns about Ukraine's future recovery and security assurances from the U.S. (03:02).

• Market Performance: The S&P 500 is down 10% year-to-date, and the Nasdaq has declined by 17%, indicating a turbulent market environment. This segment also mentions the closure of stock and bond markets in the U.S., Hong Kong, and Europe due to Good Friday (03:49).

• Boston Marathon and Running Culture: The resurgence of running as a social and fitness activity is highlighted through the story of the Dogtown Running Club in St. Louis. The proliferation of running clubs and the growth of the running apparel industry underscore a broader trend towards community-based fitness (03:02 – 06:46).

---

7. Conclusion

David Brancaccio wraps up the episode by reiterating the significance of the Supreme Court's upcoming decision on preventive care. The outcome will have profound implications for millions of Americans, healthcare providers, and the broader public health infrastructure.

"This is the Marketplace Morning Report from APM American Public Media." (06:54)

Listeners are left with a comprehensive understanding of the stakes involved in this legal battle and its potential to either uphold or dismantle crucial components of the Affordable Care Act.

---

Notable Quotes with Timestamps:

• "Is it right that insurance companies have to pay the whole bill to check a person for, say, diabetes or cancer?" — David Brancaccio (00:01)

• "High value things should be cheap and low value things should be expensive." — Mark Fendrick (01:19)

• "This is something that I advocated for many years and most importantly, actually saw the impressive impact on patient behavior." — Mark Fendrick (02:14)

• "At the end of the day, what this case is about is whether insurers and employers can sort of go back to this wild west that we had before the Affordable Care Act was signed into law." — Zach Barron (02:40)

• "Even if the mandate does go away, most businesses say they plan to keep paying for this care anyways, in part because it saves money long term." — Alex Olgan (02:52)

---

Final Thoughts:

This episode of Marketplace Morning Report provides an insightful exploration of a landmark legal challenge that could fundamentally alter the provision of preventive healthcare in the United States. Through expert interviews and real-life accounts, listeners gain a nuanced perspective on the potential ramifications of the Supreme Court's decision, underscoring the delicate balance between legal interpretations, business interests, and public health imperatives.

Transcript

[David Brancaccio]

Is it right that insurance companies have to pay the whole bill to check a person for, say, diabetes or cancer? I'm David Brancaccio in Los Angeles. It is the law that insurance companies have to pay the entire costs of certain screenings for cancer, diabetes, infectious diseases and more. But patients can soon have to pick up more of the tab if the U.S. supreme Court sides with two Texas businesses. This is the fourth time the justices are hearing a challenge to the Affordable Care act, with a high court decision due this year. Alex Olgan reports.

[Alex Olgan]

Convincing patients to get mammograms, reproductive care and colonoscopies are a huge part of Alison Ruff's job as a primary care doctor at the University of Michigan.

[Alison Ruff]

I spent three years probably convincing this one male patient in his 60s to get his colonoscopy, she says.

[Alex Olgan]

He finally got the procedure and told Ruff doctors found and removed a precancerous growth.

[Alison Ruff]

He was totally overwhelmed. He was like, thank you, doc. They were able to remove it completely. I don't have cancer. But if we'd waited another year, it would have been a very different conversation.

[Alex Olgan]

Since 2010, screenings for Colon cancer, chronic diseases, and vaccinations have increased. That's when the Affordable Care act required insurers to pay for these kinds of important preventive care.

[Mark Fendrick]

High value things should be cheap and low value things should be expensive.

[Alex Olgan]

This idea that Dr. Mark Fendrick and a colleague came up with is called Value Based Insurance Design. He now runs a center with that name at the University of Michigan. Fendrick's idea made it into the aca. Now, every year, an independent panel of doctors and medical experts update which preventive care should be free for patients.

[Mark Fendrick]

And one of the great things about it is it's a gift that keeps on giving.

[Alex Olgan]

But in 2022 Texas businesses disagreed. They say in court filings the requirement to pay for HIV prevention meds, contraception and STD testing violates through company insurance, the religious beliefs. And they argue the medical experts who decide which preventive care should be free were illegally hired and are too independent. When Fendrick heard about the case, he said it felt like a punch in the gut.

[Mark Fendrick]

This is something that I advocated for for many years and most importantly, actually saw the impressive impact on patient behavior.

[Alex Olgan]

He worries if the justices overturn this guaranteed free care, it could reverse more than a decade of public health progress. Zach Barron, director of the center for Health Policy and the Law at Georgetown, says this case threatens a return to the days before standardized coverage.

[Mark Fendrick]

At the end of the day, what this case is about is whether insurers and employers can sort of go back to this wild west that we had before the Affordable Care act was signed into law.

[Alex Olgan]

Even if the mandate does go away, most businesses say they plan to keep paying for this care anyways, in part because it saves money long term. I'm Alex Olgan for Marketplace.

[David Brancaccio]

Ukraine says it has signed a memorandum of intent to sell minerals to the United States. The BBC's Ukraine correspondent James Waterhouse has more.

[James Waterhouse]

This is a deal, it seems, that goes far beyond critical minerals. It focuses on Ukraine's energy infrastructure, its natural resources, including oil and gas, and American control of that. At the very least, it seems we have a joint fund where Ukrainian profits would go into that and then that fund would be invested into Ukraine's recovery. What it seemingly does not have still are concrete security guarantees that Ukraine desperately wants from America, that it would step in if a ceasefire was broken down the line. But at the very least, I think Kyiv is hoping this will turn into something more and perhaps the money will be welcomed when the moment arrives for the country to try and get back on its feet.

[David Brancaccio]

Secretary of State Marco Rubio said yesterday the US Will decide in a few days if arranging an end to the war between Russia and Ukraine is, quote, doable. Whether this means the US Would back away from brokering peace or from supporting Ukraine more generally is not clear. Stock and bond markets in the US Hong Kong and Europe are closed today. Good Friday. The S and p is down 10% year to date. The Nasdaq is down 17%. Monday's at the Boston Marathon, 129th said to be the world's oldest annual race of this kind. Here in 2025, running is back to get fit or stay fit or for social interaction as Daniel Ackerman, makers of running apparel are all over this.

[J.C. Wilson]

In March of 2021, J.C. wilson was emerging from the depths of COVID winter. She posted on her neighborhood Facebook group in St. Louis asking if anyone wanted to go for a jog.

[Cole Townsend]

Basically because I was just tired of running alone.

[J.C. Wilson]

And just over a dozen people showed up for that first meeting of the Dogtown Running Club. Now hundreds come if the weather's nice. And Wilson says it's not just about the running.

[Cole Townsend]

The hangout that happens afterward is really where the magic happens.

[J.C. Wilson]

Share a few drinks, meet new friends and of course, talk about the gear.

[Cole Townsend]

You know, if someone's rolling up with new shoes on, you're like, oh, those are new shoes. Where did you get those?

[J.C. Wilson]

So there has been a real spike in the number of people involved in those clubs. Neil Saunders is managing director of Global Data. According to Strava, an online exercise tracker, participation in running clubs grew by more than 50% last year, which of course is great for the industry in terms of sneakers and apparel, and it's given new arrivals to the industry a chance to compete with giants like Nike and Adidas, says Cole Townsend, founder of Running Supply.

[Alex Olgan]

It's a lot easier than it used to be to start up an apparel brand.

[J.C. Wilson]

Brands like Bandit on and Hoka are fueling much of the industry's growth right now. Sometimes they'll show up to clubs and let runners try their gear for free. Jessica Ramirez is managing director of the Consumer Collective and she says a lot of this new gear is funct like shoes with better cushioning.

[Cole Townsend]

And to be quite frank, as women you do need more than just a big T shirt. There's sports bras that are involved and you know, if I think of Lululemon, they do have some of the most successful sports bras.

[J.C. Wilson]

But beyond comfort and performance, Ramirez says a lot of running apparel is a matter of fashion. That's in part because running is no longer just a solitary sport.

[Cole Townsend]

We've seen it as community based and a place for people to meet people. Dating, you know, replace the apps and things of that. You're still gonna wanna look nice at the end of the day for that.

[J.C. Wilson]

You know, she says. For a lot of runners, running gear has just become everyday clothing. I'm Daniel Ackerman for Marketplace and in.

[David Brancaccio]

Los Angeles I'm David Brancaccio. This is the Marketplace Morning Report from APM American Public Media.

[Jannelie Espinal]

If there's one thing we know about social media, it's that misinformation is everywhere, especially when it comes to personal finance. Financially Inclined from Marketplace is a podcast you can trust to help you get serious about your money so you can build a life you've always dreamed of. I'm the host, Jannelie Espinal, and each week I ask experts important money questions, like how to negotiate job offers, how to choose a college that you can afford, and how to talk about money with friends and family. Listen to Financially Inclined Wherever you get your podcasts.