In a pivotal 6–3 decision issued on June 27, 2025, the U.S. Supreme Court upheld a central provision of the Affordable Care Act (ACA), ensuring that health insurance plans must continue to cover a range of preventive services—such as cancer screenings, cholesterol tests, and HIV prevention medications—without cost-sharing. The ruling in Kennedy v. Braidwood Management, Inc. preserves access to essential preventive care for approximately 150 million Americans.
The case centered on the constitutionality of the U.S. Preventive Services Task Force (USPSTF), a panel of medical experts responsible for recommending preventive services that insurers are mandated to cover under the ACA. Plaintiffs, including Christian-owned businesses, argued that the USPSTF’s members were not properly appointed under the Constitution’s Appointments Clause, as they are not confirmed by the Senate. They also raised religious objections to covering pre-exposure prophylaxis (PrEP) for HIV prevention, claiming it conflicted with their beliefs.
Writing for the majority, Justice Brett Kavanaugh stated that USPSTF members are “inferior officers” because they are appointed and supervised by the Secretary of Health and Human Services (HHS), who has the authority to remove them and review their recommendations. This supervision, the Court held, satisfies constitutional requirements, thereby validating the task force’s role in shaping preventive care mandates.
The decision reverses a lower court ruling from the Fifth Circuit Court of Appeals, which had found the USPSTF’s structure unconstitutional. Had the Supreme Court upheld that decision, it could have jeopardized coverage for numerous preventive services, including screenings for diabetes, various cancers, and interventions for heart disease.
Public health advocates lauded the ruling as a significant victory for preventive medicine. Organizations such as the American Heart Association and the American Lung Association emphasized that eliminating cost barriers to preventive services is crucial for early disease detection and reducing long-term healthcare costs. They warned that reinstating co-pays or deductibles could deter individuals from seeking necessary care, potentially leading to more advanced illnesses and higher treatment expenses.
However, the ruling also underscores the considerable influence of the HHS Secretary over the USPSTF. Currently, HHS Secretary Robert F. Kennedy Jr. has the authority to appoint and remove task force members and to approve or reject their recommendations. Some experts express concern that this level of control could politicize the task force’s decisions, potentially undermining its scientific integrity. For instance, Secretary Kennedy has previously restructured other health advisory panels, raising questions about the future independence of the USPSTF.
Justice Clarence Thomas, joined by Justices Samuel Alito and Neil Gorsuch, dissented, arguing that the USPSTF exercises significant authority and should therefore be subject to Senate confirmation. They contended that the current appointment process lacks sufficient accountability and transparency.
The Court’s decision maintains the status quo for preventive healthcare coverage under the ACA, ensuring that services recommended by the USPSTF continue to be available without out-of-pocket costs. This outcome is particularly significant given the ongoing legal challenges to the ACA and debates over the role of federal agencies in healthcare policymaking.
As the healthcare landscape evolves, the Supreme Court’s ruling affirms the importance of preventive care in the nation’s health system, while also highlighting the delicate balance between expert-driven recommendations and political oversight.
