Supreme Court's ACA Ruling: A Tailwind for Gilead and Cancer Diagnostics in a Post-Reimbursement Uncertainty Era

The U.S. Supreme Court's June 2025 ruling in Kennedy v. Braidwood Management, Inc. has eliminated a major overhang for healthcare stocks tied to the Affordable Care Act (ACA), particularly those in preventive care and diagnostics. By upholding the ACA's requirement for insurers to cover U.S. Preventive Services Task Force (USPSTF)-recommended services without cost-sharing, the decision removed near-term regulatory uncertainty for companies like Gilead Sciences (GILD) and cancer diagnostics firms. This article examines how the ruling serves as a market catalyst for these sectors, while emphasizing the need for selective investing in firms with robust pipelines, pricing power, and alignment with long-term reimbursement stability.

The Ruling's Immediate Impact: Removing Coverage Uncertainty

The Supreme Court's 6-3 decision affirmed that the USPSTF's structure complies with the Constitution, preserving cost-free access to preventive services for 150 million Americans. This includes critical therapies like Gilead's HIV pre-exposure prophylaxis (PrEP) drug Yeztugo, as well as cancer screenings (lung, breast, and colon) and vaccines. The ruling quashes efforts to dismantle ACA protections, ensuring stable demand for these therapies and diagnostics.

Why this matters for investors: - Reimbursement certainty reduces the risk of insurers imposing copays or dropping coverage for essential treatments.- Expanded access to preventive care will drive earlier disease detection, boosting demand for diagnostics and therapies. For example,肺癌筛查率每提升10%，可使晚期肺癌患者减少约15% (根据美国癌症协会数据).

Gilead: A Leader in PrEP and Oncology, Positioned for Growth

Gilead's stock (GILD) has risen +12% YTD through June 2025, outperforming broader healthcare indices, as investors price in the ACA ruling's benefits. Key tailwinds include:

1. Yeztugo Dominance: As the only once-monthly PrEP option approved by the FDA, Yeztugo addresses a critical gap in HIV prevention. The Supreme Court's decision ensures its coverage remains intact, enabling Gilead to capitalize on surging demand. The drug's annual revenue could hit $2 billion by 2027, driven by expanded access in underserved populations.

2. Cancer Pipeline: Gilead's oncology portfolio, including the CAR-T therapy Yescarta and the immuno-oncology drug Tecvayli, is bolstered by the ACA's emphasis on early cancer detection. More patients receiving timely diagnoses will increase the addressable market for targeted therapies.

Cancer Diagnostics: Mixed YTD Performance, But Long-Term Tailwinds

While GILD has thrived, some cancer diagnostics stocks like Exact Sciences (EXAS) have underperformed (-5% YTD), reflecting sector-specific challenges. However, the ACA ruling strengthens their long-term outlook by ensuring sustained demand for screenings:

• Exact Sciences' Cologuard: A non-invasive colorectal screening tool, its adoption should grow as the ACA's coverage mandate lowers patient cost barriers. The company's 2025 revenue guidance of $1.8–$1.9 billion assumes 15% YoY growth, but execution risks (e.g., competition from lab-developed tests) persist.

• Liquid Biopsy Innovators: Companies like Grail (acquired by Illumina) and Guardant Health (GH) rely on early cancer detection trends. The ruling's expansion of screening access creates a fertile environment for these high-margin diagnostics, though reimbursement hurdles remain.

Investment Thesis: Selectivity is Key

The ACA ruling eliminates a major regulatory risk, but investors must differentiate between winners and losers:

Buy: GILD for its Yeztugo dominance and oncology pipeline. Its pricing power and alignment with reimbursement trends make it a top pick.
Hold: EXAS until it demonstrates execution in an increasingly competitive space. The ACA tailwind is real, but its valuation must reflect execution risks.
Avoid: Pure-play diagnostics firms with no proprietary IP or reliance on lab-developed tests (e.g., Quest Diagnostics)—they face pricing pressure and regulatory scrutiny.

Risks and Considerations

• Generic Competition: Yeztugo's exclusivity could face threats if generics enter the market post-2030, but its monthly dosing advantage may deter competition.
• USPSTF Updates: The task force's recommendations (e.g., for lung cancer screening eligibility) could shift, impacting diagnostics demand. Investors should monitor its annual guideline changes.

Conclusion: A New Era of Reimbursement Stability

The Supreme Court's decision marks a turning point for ACA-linked therapies and diagnostics. For investors, the focus should shift from regulatory risk to fundamental execution: pipelines, pricing, and market share. Gilead's leadership in PrEP and oncology, combined with its financial flexibility, makes it a standout name. Meanwhile, diagnostics firms must prove they can leverage expanded access into sustainable growth.

In this post-ruling environment, selective investing in companies that benefit from both reimbursement certainty and clinical innovation will yield the strongest returns. The ACA's preventive care mandate isn't just a policy win—it's a multiyear growth driver for healthcare stocks with the right moats.