Blog Post

How One Study Helped Save Free Preventive Care in a Supreme Court Showdown

A 2024 Study Showing How Even Small Copays Reduce PrEP Use Fueled Media, Legal, and Advocacy Efforts As Courts Weighed a Case Threatening No-Cost Preventive Care for Millions

January 13, 2026

By:

Karl Stark

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When LDI Senior Fellow Jalpa Doshi and collaborator Lorraine Dean of Johns Hopkins University published a landmark paper in 2024 showing how rising copays restrict preventive care, many researchers might have logged the study on their CVs and moved on.

But Doshi and Dean didn’t follow the script. When a federal court case threatened to virtually eliminate free preventive care in the United States, the pair realized their study could show judges how damaging that would be. They sprang into action, translating their work into an infographic, op-ed, and other materials to share with the article’s release in Health Affairs in early 2024.

“Once the paper was published, the outreach campaign took over my life for a while,” Doshi recalled. “It was pretty insane.”

“We were doing it because we were passionate about it,” Dean added. “These are the moments we live for as researchers.”

The pair ended up contacting reporters and lawyers writing legal briefs, publicizing the fact that raising out-of-pocket costs for preventive care would keep millions of people from getting the help they needed.

But would anyone listen?

How Patients React When Copays Rise on Preventative Services

Doshi, Dean and their team produced the first national study showing how even small copays reduced the use of the drug regimen pre-exposure prophylaxis, or PrEP, to prevent HIV.

Just a small jump in copays from $0 to $10 was linked to doubling the risk that patients would not get their PrEP prescriptions, substantially raising their chances of contracting HIV over the next year.

And if PrEP’s out-of-pocket costs rose from $0 to $100 or more, abandonment rates would soar by six to eight times, with more than one-third of patients refusing their prescriptions.

Their work, funded by a National Institutes of Health (NIH) R21 grant, was published in January 2024.

By then, an ominous court case was gathering momentum that could have taken down PrEP and free preventive care required by the Affordable Care Act.

Braidwood Management, a Christian-owned wellness center, and six individuals in Texas called requirements for free preventive care unconstitutional and said that requiring coverage for HIV drugs for PrEP violated their religious rights.

In September 2022, a federal judge in Texas agreed with Braidwood, and struck down the coverage mandate. But the federal government appealed the ruling to the U.S. Court of Appeals for the Fifth Circuit in New Orleans, which let the coverage mandate stand during its deliberations. On appeal, Braidwood’s primary challenge shifted to maintain that the U.S. Preventive Services Task Force, which recommends preventive services based on evidence, was not constitutionally appointed and that no one should be required to accept its recommendations.

In June 2024, the Fifth Circuit agreed with Braidwood that the task force was not constitutionally appointed but limited the ruling to the plaintiffs because they had sought a nationwide remedy too late in the process.

The Campaign to Disseminate Good Research

Still, the threat escalated when the case reached the U.S. Supreme Court.

About 100 million privately insured people receive free preventive services each year, like mammograms, vaccines, and much more. The researchers wanted to ensure the impact of rising copays on patients somehow reached judges who would rule on the case.

So they mobilized a campaign that began when their paper was published in January 2024.

The two researchers—with the help of collaborator Amy Nunn of Brown University—sent personal emails to experienced health reporters and got a surprising response. Ten reporters wrote stories highlighting their concerns, in such outlets as Bloomberg News, NBC News, and U.S. News & World Report.

Over time, the study’s impact grew, generating 58 mentions by news outlets, according to Health Affairs.

The pair also wrote an op-ed that initially drew no interest from editors because the case was moving slowly and might not amount to anything. But after the Fifth Circuit ruled, their piece was snapped up by The Hill, a major Washington D.C. outlet focused on politics. “PrEP now or pay later,” the headline warned.

Not content with words, Doshi and Dean sent around a graphic illustration of their concerns to major figures in research and to lawyers upholding preventive care before the Supreme Court.

In a Wharton leadership program years ago, Doshi said she learned that you don’t need to know everybody. You just need to know a few well-connected individuals who can help amplify your work.

Dean and Doshi followed that advice in spades, reaching out to leading patient advocacy groups, academics, grassroots groups, and other nonprofits keen to protect no-cost PrEP. Eventually, lawyers cited their findings in nine amicus briefs before the Supreme Court, including one from the American Cancer Society.

The Need to Disseminate Good Research Has Never Been Greater

In the end, the court preserved free preventive care by a 6-3 vote in June 2025, averting what the investigators thought could have been a public health catastrophe.

Many media outlets noted Doshi and Dean’s research in their coverage of the Supreme Court decision to highlight the negative consequences that the decision averted.

But the fight remains far from over. The decision gave the U.S. Department of Health and Human Services (HHS) Secretary the power to remove preventive task force members or add ones who would overturn past recommendations. Other court cases continue to threaten preventive care.

As scientists, Dean and Doshi are reluctant to say that their research played a role in the decision, but the gracious responses from HIV advocacy groups led them to believe that it helped.

The case underscores the importance of dissemination and how it’s often a missing piece in connecting research to people who can use it.

“I’m applying this dissemination approach to every piece of work I’m doing,” Doshi said. “I’m choosing what I’m going to be working on based on its potential for impact.”

The study, “Estimating The Impact Of Out-Of-Pocket Cost Changes On Abandonment Of HIV Pre-Exposure Prophylaxis,” was published January 2024 in Health Affairs. The authors include Lorraine T. Dean, Amy Stewart Nunn, Hsien-Yen Chang, Shivani Bakre, William C. Goedel, Rahel Dawit, Parya Saberi, Philip A. Chan, and Jalpa A. Doshi.