In a landmark decision, the U.S. Supreme Court has upheld the Affordable Care Act’s preventive care coverage mandate in a 6-3 vote, affirming that the U.S. Preventive Services Task Force can continue issuing recommendations for services that must be covered by health insurers without cost-sharing.
The ACA currently mandates insurers cover over 100 preventive health services, benefiting around 150 million people annually.
The court ruled that members of the USPSTF are “inferior officers” and not “principal officers,” which means they can be appointed by the HHS secretary rather than requiring Senate confirmation.
“The Task Force members are removable at will by the Secretary of HHS, and their recommendations are reviewable by the Secretary before they take effect,” Justice Kavanaugh wrote for the court majority. “So Task Force members are supervised and directed by the Secretary, who in turn answers to the President, preserving the chain of command in Article II.”
Braidwood Management, a Texas company, and other individuals originally sued HHS in 2021, arguing that the task force’s requirement to cover an HIV-prevention medication violated its religious freedoms. In March 2023, U.S. District Judge Reed O’Connor ruled that recommendations made by the USPSTF after 2010 do not need to be followed. The decision also blocked the government from enforcing task force recommendations among private health insurers. HHS under the Biden administration then reached a deal to temporarily preserve the preventive care mandate while the case proceeded through the courts.
In June 2023, the 5th U.S. Circuit Court of Appeals issued a mixed ruling on the case. While it agreed that Braidwood should not be required to cover PrEP for its employees, it also reversed Judge O’Connor’s earlier decision blocking the preventive care mandate for all health plans. The appeals court wrote that because the USPSTF’s members are not confirmed by the Senate, their authority to mandate coverage is unconstitutional. However, the ruling only applied to the plaintiffs, leaving the broader preventive care mandate intact.
In February, the Justice Department under the Trump administration filed a brief with the Supreme Court, arguing in favor of maintaining the Biden administration’s stance to uphold the authority of the task force to mandate coverage for preventive services.
