Supreme Court Upholds ACA’s Preventive Services Requirement, but Future Unclear

A recent U.S. Supreme Court decision affirmed the constitutionality of the Affordable Care Act’s (ACA) mandate for insurers to cover, with no cost sharing, preventive services recommended by a national task force. The ruling preserves, at least for now, no-cost access to critical health services for millions of Americans.

The future of the U.S. Preventive Services Task Force and its recommendations is uncertain, however, after U.S. Health and Human Services Secretary Robert F. Kennedy Jr. called off the task force’s July meeting just days before it was to have taken place.

In a 6-3 decision in the case Kennedy v. Braidwood Management Inc., the Supreme Court on June 27 affirmed the constitutionality of the Affordable Care Act’s mandate for insurers to cover, with no cost sharing, preventive services recommended by the U.S. Preventive Services Task Force (USPSTF). The plaintiffs in the case had argued that the task force’s members are not constitutionally empowered to make binding recommendations. The suit maintained that the U.S. secretary of health and human services cannot modify or reject the USPSTF’s recommendations, so the members effectively act as federal officers and therefore are required under the Appointments Clause of the U.S. Constitution to be appointed by the president and confirmed by the Senate, which the task force’s members have not been.

The case originated from a challenge by Braidwood Management, a Christian-owned business that runs a health and wellness center in Houston. Braidwood argued that being required to provide coverage for pre-exposure prohylaxis (PrEP) for the prevention of HIV, a service recommended by the USPSTF, burdened the company’s exercise of religion in violation of the Religious Freedom Restoration Act. The challenge was expanded to add plaintiffs and question the constitutional authority of the USPSTF.

In 2022, a federal district judge in Texas sided with the plaintiffs, finding that USPSTF members exercised significant authority without being appointed by the president or confirmed by the Senate, and thus they were unconstitutionally empowered. The judge also agreed with the plaintiffs that requiring them to cover PrEP violated their rights under the Religious Freedom Restoration Act. In 2023, the same judge invalidated the Affordable Care Act’s requirement to cover USPSTF-recommended services issued after March 23, 2010, but stayed the decision pending appeal. In 2024, the Fifth Circuit Court of Appeals affirmed the ruling that the USPSTF’s structure was unconstitutional but limited the ruling to the plaintiffs, rejecting a nationwide block.

The Supreme Court reversed the lower-court rulings, finding that the secretary of health and human services exercises sufficient supervision over the USPSTF, including the power to appoint and remove members at will and to review and block recommendations before they become binding on insurers. Because the secretary controls when, if at all, recommendations take effect, the USPSTF members do not exercise final decision-making authority, the court found. It held that USPSTF members are “inferior officers” whose appointment structure complies with the Appointments Clause. As a result, the ACA’s preventive services mandate remains intact regarding the USPSTF’s recommendations.

However, Kennedy previously removed all the voting members of the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP), which makes vaccine recommendations. He could exercise his authority — expressly confirmed in the Kennedy v. Braidwood Management Inc. decision — to remove some or all of the USPSTF’s members as well.

Additionally, legal challenges are pending related to the ACA’s mandate for insurers to cover services recommended by other expert panels. In their original lawsuit, the plaintiffs in Kennedy v. Braidwood Management Inc. argued that it is unconstitutional for the ACA to require insurers to provide no-cost coverage not only for preventive services recommended by the USPSTF but also for services for women and children recommended by the Health Resources and Services Administration, such as contraception and breastfeeding services and supplies, and for vaccines recommended by ACIP. Those claims remain under review in lower courts and could reach the Supreme Court in the future.

In previous posts, we have discussed a few of the dozens of critical preventive services recommended by the USPSTF, including:

• Diabetes screening for at-risk adults
• PrEP for at-risk adults
• Blood pressure checks during pregnancy
• Breast cancer screening for women 40 and older
• Behavioral interventions to address childhood obesity
• Osteoporosis screening for women 65 and older
• Colorectal cancer screening for people ages 45 to 75
• Primary care interventions to support breastfeeding
• Syphilis screening during pregnancy