Supreme Court Upholds Obamacare’s Free Preventive Care Rule (4)

The Supreme Court upheld the lawfulness of an Obamacare provision that requires insurers to cover certain preventive health-care services like cancer screenings free of charge.

In a 6-3 ruling Friday, the court’s majority said the task force that recommends which services should be covered is consistent with the Constitution.

The US Court of Appeals for the Fifth Circuit had said the structure of the US Preventive Services Task Force violates the Constitution’s appointments clause because its members are principal officers who have to be appointed by the president with advice and consent of the Senate.

But writing for the majority, Justice Brett Kavanaugh said the health secretary can remove them at will and their recommendations are reviewable by the secretary, which makes them inferior officers.

The court also said Congress gave the secretary the power to appoint the task force members, which was a question the justices had asked the parties to submit additional briefing on after arguments in April.

“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,” Kavanaugh said.

Two conservative Christian employers and four individuals in Texas challenged the structure of the task force in objecting to the Affordable Care Act’s mandate that insurers and group health plans cover the HIV preventive drug PrEP. The medications “encourage and facilitate” same-sex relations, they said, and conflict with their beliefs.

Justice Clarence Thomas wrote a dissenting opinion that Justices Samuel Alito and Neil Gorsuch joined in which he accused the court of rushing to rule on the government’s new theory that the health secretary has this appointment power.

“But, if we are to decide this question now, I do not see how Congress has spoken with the clarity needed to depart from the default rule established by the Appointments Clause,” he said.

Under the Constitution, Thomas said appointment by the president with Senate confirmation is the rule.

“Appointment by a department head is an exception that Congress must consciously choose to adopt,” he said.

Praise With Concern

Patient advocacy groups and attorneys following the case overall were pleased with the ruling.

“The Supreme Court rightly rejected a constitutional challenge that would have eliminated the Affordable Care Act cost-free coverage requirement for numerous life-saving preventive care services,” Protect Our Care, one of the groups leading the defense, said in an emailed statement.

“Approximately 150 million Americans rely on the ACA for free access to services like cancer screenings, statins to address high cholesterol levels, mental health screenings, HIV prevention medication, and more,” the group said.

The “Supreme Court decision is a resounding victory for the health of our nation,” said Michael Sapienza, chief executive officer of the Colorectal Cancer Alliance.

Andrew Pincus of Mayer Brown LLP in Washington said that absent this decision, millions of Americans “would have been returned to the pre-ACA era, when insurers refused to cover these services at all, or required consumers to shoulder a share of the cost, which put vital preventive care out of reach for many.”

And Andrew Twinamatsiko said the top court’s decision was about “as good as people had hoped,” preserving the status quo and ensuring that people with health insurance plans can access preventive services without having to pay out of pocket. Twinamtsiko is a director of the Center for Health Policy and the Law at the O’Neill Institute of Georgetown Law.

Insurers must still pay for services that are already in effect, Twinamatsiko said.

But Protect Our Care remains concerned about what the top court’s decision means going forward, according to senior adviser Anne Shoup. The ruling “protects preventive care for now,” but the Trump administration and US Department of Health and Human Services Secretary Robert F. Kennedy Jr. are still trying to weaken the ACA, she said.

Pincus echoed the concerns.

“It’s possible that a USPSTF with new members appointed by Secretary Kennedy could revoke certain preventive service recommendations, like particular screenings or drugs—and Secretary Kennedy would either approve the revocation or just allow it to go into effect,” Pincus said.

“That would open the door for proponents of the coverage to sue HHS under the APA, arguing that the revocation was arbitrary, capricious, and contrary to law,” he said. “HHS then would have to explain why the agency changed its position and convince the court that there was a sufficient scientific basis for the revocation decision under the standard for USPSTF decisions.”

HHS doesn’t generally comment on litigation, a spokeswoman said Monday. Attorneys for Braidwood Management Inc. didn’t respond to a request for comment.

The case is Kennedy v. Braidwood Mgmt., Inc., U.S., No. 24-316, 6/27/25.