The Supreme Court on Friday rejected a challenge to a crucial component of the Affordable Care Act, affirming the oversight of a panel of medical experts who recommend preventive care for health insurance coverage is constitutional.
This means services like lung and colon cancer screenings, HIV prevention medication, statins for heart disease, and various pregnancy screenings, which have been recommended by the panel, could continue to be covered free of charge for the 150 million Americans who have private insurance.
In the ruling, the court held that members of the United States Preventive Services Task Force, a group of independent medical experts, are considered “inferior officers” and “at will” under the secretary of the Department of Health and Human Services. The case had challenged the structure of the panel, calling into question its authority to make recommendations for what types of preventive care insurers are required to cover and threatening access to the no-cost care it recommends.
The court reversed an appeals court decision and sent the case back down to lower courts for future proceedings. Justice Brett Kavanaugh wrote the 6-3 majority opinion, with Justices Clarence Thomas, Sam Alito and Neil Gorsuch dissenting.
“The structure of the Task Force and the manner of appointing its officers preserve the chain of political accountability that was central to the Framers’ design of the Appointments Clause,” Kavanaugh wrote in the opinion.
The exact scope of preventive care coverage in America still remains uncertain, however, as HHS Secretary Robert F. Kennedy Jr. and Republicans threaten to undermine the nation’s top health agency, and in particular have focused on gutting Medicaid, as well as dismantling and defunding an array of public health infrastructure.
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The case, Kennedy v. Braidwood, initially grew out of a 2020 challenge by Braidwood Management Inc., a Texas-based company that sued the federal government because it believed the ACA’s requirement that the company provide coverage for pre-exposure prophylaxis — an HIV preventive medication known as PrEP — violated its religious rights under the Religious Freedom Restoration Act.
In this case, Dr. Steven Hotze, the sole trustee and beneficiary of Braidwood, said he was unwilling to pay for PrEP or sexually transmitted infection screenings for his employees due to his Christian faith. “[The health screenings] are consequences of a patient’s choice to engage in drug use, prostitution, homosexual conduct, or sexual promiscuity — all of which are contrary to Dr. Hotze’s sincere religious beliefs,” the complaint read.
The current case did not concern questions of religious freedoms. Instead, today’s decision repudiates decisions from lower courts, reaffirming that members of the task force, appointed by the health secretary, have the power to recommend preventive health care to be covered by health insurers under the U.S. Constitution.
In 2022, a district court sided with Braidwood and ruled that forcing the company to cover PrEP did violate its religious freedoms. But in 2024, President Joe Biden’s Department Health and Human Services secretary, Xavier Becerra, appealed the decision. The 5th U.S. Circuit Court of Appeals later affirmed the district court’s decision that the task force’s role in determining preventive services was unconstitutional and limited the enforcement of this order solely to Braidwood. But once Biden left office, the Trump administration agreed to pick up the case and defend the task force’s authority.
Kennedy’s defense of the task force came as somewhat of a surprise to many legal and public health experts, who have worried that the Trump administration’s support of this case may come at the price of more executive control over the agency.
During the oral arguments for the case, the Trump administration argued that the task force’s existence was constitutional because the health secretary has the power to hire and fire members and reject their recommendations — a power the secretary has not previously exercised.
The Supreme Court’s acceptance of that argument could tee up a scenario where some preventive health service recommendations are saved and others are not — depending on what the head of the department deems important.
It’s of particular concern with Kennedy, a known conspiracy theorist and vaccine denier, at the helm. Kennedy has already made significant changes to the top health agency, refocusing it in line with his own agenda. While he maintains his purpose is to prevent chronic disease, his pivots have largely defied the existing scientific consensus, while dramatic funding cuts and restructuring of HHS have stymied decades of research into diabetes, asthma and kidney disease prevention. Already RFK Jr.’s plans for HHS have decimated the nation’s HIV prevention programs, setting back decades of progress in terms of prevention, treatment and research to communities most at risk.
LGBTQ+ health and legal advocates applauded Friday’s ruling, which protects access to PrEP at no cost to patients, but urged the HHS secretary to champion science and not political ideology.
“The Court has made the right decision … upholding essential protections for preventive services and affirming the prevention and early detection of diseases saves lives,” a coalition of executive directors from Lambda Legal, PrEP 4 All, the Center for Health Law and Policy Innovation, the Center of HIV Law and Policy, and Equality Federation wrote in a statement.
“The Secretary’s expanded grip on the USPSTF could open the door to abuses, enabling administrations to sideline medical experts, shape recommendations to match political agendas, and jeopardize evidence-based healthcare for millions of Americans,” they added.