On June 27, 2025, the U.S. Supreme Court announced its long-awaited opinion in Kennedy v. Braidwood Management, Inc., which challenged the legality of ACA preventive care coverage requirements. The Court ruled that members of the U.S. Preventive Services Task Force (USPSTF), an HHS entity that makes evidence-based recommendations regarding preventive healthcare services, were properly appointed under the U.S. Constitution. As a result, group health plans must continue to cover all ACA-required preventive care without cost-sharing, including items and services that receive “A” or “B” ratings from the USPSTF.
Background
In Braidwood, the plaintiffs are several small businesses and individuals who object to the ACA mandate that requires insurers and group health plans to cover certain preventive care without cost-sharing. The lead plaintiff, Braidwood Management, Inc., offers health coverage to approximately 70 employees through a self-insured plan and wants to exclude coverage for certain preventive care drugs and impose copays or deductibles for other preventive services.
The plaintiffs argued that members of the USPSTF were not appointed in accordance with constitutional requirements for appointing either principal or inferior U.S. officers. Therefore, according to the plaintiffs, the USPSTF preventive care recommendations should be voided, so plans and insurers would not be required to cover those items and services without cost-sharing.
The Texas district court agreed with the plaintiffs, ruling that USPSTF members were principal officers who had not been properly appointed. The Fifth Circuit affirmed this ruling on appeal. (See our October 11, 2022, April 3, 2023, and July 2, 2024, editions of Compliance Corner for further details on the prior court decisions.)
Following the Fifth Circuit ruling, the Biden administration’s Department of Justice appealed the case to the Supreme Court. Both the Biden and succeeding Trump administrations argued that the USPSTF members are inferior officers and thus may be appointed by the HHS secretary. (See our February 25, 2025, article for more information on the executive branch’s position.)
The Supreme Court’s Opinion
In a 6-3 decision, the Supreme Court reversed the Fifth Circuit ruling and, agreeing with the Trump administration, held that the USPSTF members were inferior officers who were appointed in accordance with the Constitution. The opinion, written by Justice Kavanaugh, explains that USPSTF members are inferior and not principal officers because their work is “directed and supervised” by the HHS secretary, who is a principal officer appointed by the president and confirmed by the Senate. Specifically, the HHS secretary has the power to remove USPSTF members at will and statutory authority to directly review and block USPSTF recommendations prior to their effective dates. In reaching its conclusion, the Court largely rejected the plaintiffs’ argument that Congress intended the USPSTF to be an independent agency, whose members wield power to make preventive care recommendations unchecked by the HHS secretary.
Furthermore, the Court dispelled assertions by the plaintiffs and the dissent that Congress had not given the HHS secretary authority to appoint USPSTF members. The opinion specifies how Congress, through two laws taken together, expressly vested the power to appoint USPSTF members in the HHS Secretary, thus validating the secretary’s appointments to date.
The Court remanded the case back to the lower court for further proceedings consistent with the opinion.
Employer Takeaway
For group health plan sponsors, the Court’s decision essentially preserves the status quo, meaning non-grandfathered group health plans must continue to cover all preventive care required by the ACA without cost-sharing. As confirmed by the opinion, this requirement includes items and services that receive “A” or “B” ratings (based on the degree of certainty of a net benefit) from the USPSTF. Accordingly, plan participants will continue to be able to receive USPSTF-recommended screenings for diabetes and lung, breast, cervical, and colorectal cancer; statin medications to prevent heart disease; nicotine patches to curtail tobacco use, among numerous other items and services, without cost-sharing.
Of course, in addition to the USPSTF recommendations, plans and insurers must also continue to cover without cost-sharing any vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) and preventive care and screenings for children and women recommended by the Health Resources and Services Administration. Please see our June 17, 2025, article for further details on the general ACA preventive care coverage requirements.
Additionally, the Court’s ruling reinforces the significant control that the HHS secretary has over the USPSTF. Historically, the USPSTF has been comprised of a key panel of healthcare experts who have played a critical role in evaluating preventive services. The HHS secretary, with newly confirmed authority to appoint, supervise, and remove USPSTF members and block recommendations he does not agree with, arguably may be able to reshape the scope of covered preventive care. The current HHS secretary, Robert F. Kennedy, Jr., has already made significant ACIP staffing changes, which could potentially affect vaccine recommendations.
Accordingly, employers should be aware of the Braidwood decision and monitor developments regarding preventive services coverage requirements closely. We will report relevant updates in Compliance Corner.