In a 6-3 ruling, the Supreme Court on Friday, June 27 supported a key provision in the Affordable Care Act around preventive healthcare services and denied the plea of a group of religious conservatives who had contended that enforcing a preventive care mandate under the Affordable Care Act (ACA) in effect discriminated against them on religious grounds. Justice Brett Kavanaugh wrote the decision for the majority; only Justices Samuel Alito, Neil Gorsuch, and Clarence Thomas dissented.
The legal arguments revolved around a somewhat technical issue, which was whether the U.S. Preventive Services Task Force was unconstitutionally appointed; the plaintiffs argued that the panel’s members were so powerful that they amounted to “principal officers” under the Constitution’s appointments clause and were illegally impaneled for not having been appointed by the President (in this case, Joe Biden) and confirmed by the Senate. The six justices in the majority strongly rejected that line of thinking, and kept in place the guideline requiring that health plans provide a range of specified health screenings. The plaintiffs had specifically objected to the medication PrEP, which prevents the transmission of HIV, being included on that list, arguing that doing so encourages sexual activity.
As POLITICO’s Alice Miranda Ollstein, Josh Gerstein, and Lauren Gardner wrote on Friday morning, “The The Supreme Court has preserved the provision of the Affordable Care Act that requires insurance companies to cover preventive health services like colonoscopies and HIV prevention drugs at no cost to patients. It’s the fourth time in the past 13 years that the high court has rejected major challenges to the 2010 health law. This time around, the vote was 6-3, with Justice Brett Kavanaugh writing the majority opinion for a cross-ideological majority. Three of the court’s conservatives dissented. The case centered on a panel of experts known as the U.S. Preventive Services Task Force. The Affordable Care Act authorized the task force to specify health screenings and other preventive services that insurers must cover without charging patients copayments, deductibles or other cost-sharing. Tens of millions of Americans rely on those services, including cancer screenings, heart disease medications and the drug, known as PrEP, that prevents the transmission of HIV.”
As the POLITICO reporters noted, “Opponents of the ACA who object to the HIV drug argued that the task force — which is chosen by the secretary of Health and Human Services — was unconstitutionally appointed. The task force members, the opponents argued, wield so much power that they amount to “principal officers” under the Constitution’s appointments clause and must be appointed by the president and confirmed by the Senate. The Supreme Court rejected that argument, reasoning that the members are not principal officers because the health secretary can ignore their recommendations, fire them and replace them.”
Justice Kavanaugh wrote for the majority that “Task Force members issue preventive-services recommendations of critical importance to patients, doctors, insurers, employers, healthcare organizations, and the American people more broadly. In doing so, however, the Task Force members remain subject to the Secretary of HHS’s supervision and direction, and the Secretary remains subject to the President’s supervision and direction. 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.”
The POLITICO reporters noted that “The Trump administration surprised many when it revealed earlier this year that it would continue the Biden administration’s defense of the Obamacare provision. But it shifted the focus of the federal government’s legal argument. The Biden Justice Department had argued in lower courts that free preventive care was crucial for the health of millions of American patients. The Trump DOJ, on the other hand, focused during oral arguments before the Supreme Court in April on preserving executive power and fending off judicial and legislative encroachments.”
Meanwhile, also on Friday morning, The Hill’s Nathaniel Weixel wrote that “The justices found the secretary of the Department of Health and Human Services (HHS) has the authority to appoint and fire members of the U.S. Preventive Services Task Force; their work is ‘directed and supervised’ by the HHS secretary, so they do not need to be confirmed by the Senate. In siding with the Trump administration, the court reinforced the ability of HHS Secretary Robert F. Kennedy Jr. to exert control over the panel’s recommendations. The health law requires insurers cover services the task force recommends with a ‘grade’ of A or B, such as cancer screenings and HIV-prevention drugs. The task force is composed of medical experts who serve four-year terms on a volunteer basis. They are appointed by the HHS secretary and are supposed to be shielded from political influence. Congress designed the task force to be ‘independent and, to the extent practicable, not subject to political pressure.’ The case began when conservative Texas small businesses and individuals sued over the panel’s recommendation that pre-exposure prophylaxis (PrEP), medicine that is highly effective at preventing HIV, be included as a mandatory preventive-care service. They said covering PrEP was against their religious beliefs and would ‘encourage homosexual behavior, intravenous drug use, and sexual activity outside of marriage between one man and one woman.’”
And the Washington Post’s Justin Jouvenal wrote on Friday morning that “Health-care providers and nonprofit organizations say the case could have blocked critical health care for many Americans. A Stanford University study estimated nearly 40 million Americans use the act’s preventive services. Lawyers defending President Donald Trump in his classified documents case last year made a similar argument about special counsel Jack Smith, and convinced a federal judge appointed by Trump in his first term to toss the indictment. The health and human services secretary has made appointments to the panel since 2023. Hashim Mooppan, principal deputy solicitor general, told the justices that task force members are inferior officers since they serve at will under the secretary of the Department of Health and Human Services. The secretary also supervises the panel and decides when its recommendations take effect. The preventive-care mandate covers dozens of services — from statins for to preventing heart disease to screenings for hepatitis B and HIV,” he added.
Leaders at the Washington, D.C.-based United States of Care, a non-partisan organization dedicated to preventive care and public health advancement nationwide, were among the first to issue a statement on the ruling. Co-founder and CEO Natalie Davis said on Friday morning that, “Today, the Supreme Court correctly upheld one of the most important and popular components of our health care system – the requirement that most private health insurance cover preventive services without cost for people. At United States of Care, we hear from people all the time that they worry their health care won’t be there when they need it. Today’s decision helps ease some of that anxiety by preserving no-cost access to care people need to stay healthy. We know that even small cost barriers can cause people to delay or skip care – often leading them into needing more expensive forms of care down the line. We also know that no-cost preventive care is wildly popular, with 92 percent of Democrats and 72 percent of Republicans expressing support. By protecting people’s access to no-cost preventive services, the Supreme Court has reaffirmed people’s right to access care that will help keep them healthy,” Davis said.
And she added that, “As we move beyond this years-long court battle to protect access to no-cost preventive care, we remain concerned about potential threats to independent expert panels that advise the Department of Health and Human Services (HHS). The evidence-based recommendations from these panels – including the United States Preventive Services Task Force – have long served as a cornerstone of preventive health policy, ensuring that coverage decisions are guided by medical expertise rather than financial or political interests. Without this framework, people could face new hurdles in accessing life-saving screenings for cancer, diabetes, and other conditions.”
Anthony Wright, executive director of Families USA, the Washington, D.C.-based healthcare consumer advocacy organization, said in a statement that, "While this is a foundational victory for patients, patients have reason to be concerned that the decision reaffirms the ability of the HHS secretary, including our current one, to control the membership and recommendations of the US Preventive Services Task Force that determines which preventive services are covered. We must be vigilant to ensure Secretary Kennedy does not undo coverage of preventive services by taking actions such as his recent firing of qualified health experts from the CDC's independent vaccine advisory committee and replacing them with his personal allies. For patients to fully benefit from this patient protection, this and future HHS Secretaries must commit to follow the nonpartisan, evidence-based advice of doctors and medical professionals in prioritizing the preventive care that provides the best benefit for the public."
And, Wright added, “The plaintiffs in this case were intent on eliminating access for a specific vulnerable population, those at risk of HIV, but as often is the case, an attack on some ends up being an attack on all. The underlying case ended up threatening free access to vital preventive services at a time when Americans are crying out for solutions to address high health care costs. Safeguarding no-cost preventive care is more essential than ever, and now Congress and the White House are continuing their efforts to undermine preventive care and coverage itself, public and private, through Medicaid and the marketplaces. At this moment, the Senate is hastily advancing a budget bill that could lead to millions of families losing access to their health care, including preventive services. While this Supreme Court decision is a positive step for preventive services, we all need to continue the vigorous defense of further attempts to reduce or cut access to health care services and coverage."
Meanwhile, AHIP, the Washington, D.C.-based national trade association representing health insurers, released the following statement on Friday morning: “Health plans have long supported affordable access to evidence-based preventive care to help people stay healthy – including coverage for recommended services with no cost sharing. With this ruling, there are no impacts to existing coverage, and we will closely monitor the ongoing legal process.”
The case is Kennedy v. Braidwood Management Inc., et al, and the full text of the decision can be found here.
This is a developing story. Healthcare Innovation will update readers with further developments, as they emerge.
