The Supreme Court upheld a popular provision of the Affordable Care Act on Friday that requires private insurers to cover a range of preventive healthcare services without cost sharing.
The 6-3 ruling is a victory for public health advocates and providers, who say the mandate preserves Americans’ access to critical care, including cancer screenings, tests for chronic conditions, and sexual health and pregnancy-related services.
The case, Kennedy v. Braidwood Management, Inc., centered on the U.S. Preventive Services Task Force, which makes recommendations on what preventive care should be covered by insurers. Plaintiffs, led by Braidwood Management, had asserted the task force violates the Constitution because the members aren’t appointed by the president or confirmed by the Senate.
But the high court sided with the federal government, determining members of the the task force are inferior officers, whose appointment by the HHS secretary is consistent with the Constitution’s Appointments Clause.
The court’s liberal justices — Sonia Sotomayor, Elena Kagan and Ketanji Brown Jackson — joined with Chief Justice John Roberts, Brett Kavanaugh and Amy Coney Barrett on the majority decision. Justices Clarence Thomas, Neil Gorsuch and Samuel Alito dissented.
“Task Force members issue preventive services recommendations of critical importance to patients, doctors, insurers, employers, healthcare organizations, and the American people more broadly,” Kavanaugh wrote in the majority opinion. “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 case has been winding its way through the courts for several years. The plaintiffs, which include two Christian-owned businesses, first sued the federal government in 2020, opposing requirements to cover contraception and medications that prevent HIV.
A district court judge sided with the plaintiffs in 2023, but the decision striking down the ACA preventive services provision did not go into effect while the Biden administration appealed the case.
Then, last year, the U.S. Court of Appeals for the 5th Circuit issued a mixed ruling on the case, finding the district court had overstepped by attempting to apply its decision nationwide. However, the appellate court ruled the task force should be confirmed by Congress.
The federal government under the Biden administration asked the Supreme Court to take up the case in September. The Trump administration also continued to defend the mandate in court, despite Republicans’ previous efforts to dismantle the law.
The government’s attorneys argued the appeals court “relied on an erroneous understanding of the Appointments Clause,” saying the HHS secretary supervises and could remove members of the task force — meaning they aren’t principal officers who have to be appointed by the president and confirmed by the Senate.
The Supreme Court agreed, reversing the lower court’s decision. The high court noted the HHS secretary has the authority to remove task force members as well as review their decisions and block them before the take effect.
“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 Task Force members were appointed by and are supervised and directed by the Secretary of HHS. And the Secretary of HHS, in turn, answers to the President of the United States,” Kavanaugh wrote.
Thomas, Alito and Gorsuch disagreed. In the minority opinion, Thomas said that for years “a subordinate official” at the HHS had appointed task force members, and the government “invented a new theory on appeal, arguing that the combination of two ambiguously worded statutes enacted decades apart establishes that the Secretary of HHS can appoint the Task Force’s members.”
