Supreme Court saves free preventive care for 150 million Americans but gives RFK Jr. politicization power

The ACA's Section 2713 requires most private health insurance plans and Medicaid expansion programs to cover services receiving an 'A' or 'B' rating from the U.S. Preventive Services Task Force without any cost-sharing — no copays, no deductibles. The mandate covers roughly 100 preventive services used by approximately 150 million privately insured Americans each year. Major services include: annual blood pressure and cholesterol screening; mammograms and colonoscopies for cancer detection; depression and alcohol use screening; tobacco cessation counseling; gestational diabetes and preeclampsia screening for pregnant women; PrEP (pre-exposure prophylaxis) for HIV prevention; and statin therapy for heart disease risk reduction. Without the ACA mandate, each of these would require cost-sharing under most employer health plans, creating financial barriers that reduce utilization and delay diagnoses.

Braidwood Management — a Houston company owned by Republican megadonor SHSteven Hotze — filed suit in March 2020 challenging multiple elements of the ACA's preventive services mandate. The company argued that covering PrEP 'facilitates and encourages homosexual behavior, prostitution, sexual promiscuity, and intravenous drug use,' and that the mandate violated the Religious Freedom Restoration Act. The plaintiffs also raised an Appointments Clause argument: the 16 USPSTF members are volunteer experts, not presidential appointees confirmed by the Senate, yet their recommendations carry the force of law by compelling insurers to cover services. The U.S. District Court for the Northern District of 🤠Texas and the Fifth Circuit both ruled for Braidwood, finding USPSTF members were 'principal officers' who required Senate confirmation.

The Appointments Clause of Article II, Section 2 distinguishes between 'principal officers' — who must be nominated by the president and confirmed by the Senate — and 'inferior officers' — whose appointment Congress can vest in the president alone, department heads, or courts. The Supreme Court has held the test turns on supervision: are the officers' decisions 'directed and supervised' by a duly appointed principal officer? HHS argued that USPSTF members are inferior officers because the HHS Secretary can remove them at will and review their recommendations before they take effect. Braidwood argued that the statutory language requiring USPSTF members to be 'independent' and 'not subject to political pressure' negated sufficient supervision.

Justice Kavanaugh's majority opinion resolved the question in favor of the government: USPSTF members are inferior officers because the HHS Secretary 'has the power to appoint (and has appointed) the Task Force members, and no statute restricts removal of Task Force members.' The majority found that 'the chain of political accountability runs from the Task Force to the HHS Secretary to the President to the American people — exactly what the Appointments Clause requires.' Kavanaugh also clarified that the Secretary has authority to 'directly review and block Task Force recommendations before they take effect' during the one-year period between recommendation and implementation, and that if the Secretary vetoes a recommendation, it simply does not become an ACA coverage mandate. Six justices — Roberts, Barrett, Kavanaugh, Sotomayor, Kagan, and Jackson — joined the majority. Justices Thomas, Alito, and Gorsuch dissented.

The ruling's immediate effect was to preserve no-cost preventive care coverage for approximately 150 million Americans. Yale epidemiologists estimated that if PrEP coverage had been eliminated, the U.S. would have seen 20,000 additional HIV infections over the next five years. The USPSTF's recommendations for blood pressure screening, cancer screenings, diabetes prevention, and maternal health services collectively prevent tens of thousands of deaths annually, according to KFF and Stanford research. The decision was celebrated by AMA, the American Cancer Society, Planned Parenthood, and public health organizations as protecting the single largest preventive health policy affecting privately insured Americans.

The ruling's most consequential downstream implication is what it authorizes future HHS secretaries to do. Kavanaugh's majority explicitly held the Secretary can: (1) remove and replace USPSTF members at will; (2) 'request' that the task force modify or withdraw specific recommendations; (3) veto recommendations during the one-year implementation window, stripping them of coverage-mandate status. No administration had ever exercised these powers before. The Trump administration's brief in the case had specifically argued for these authorities. Georgetown law professor ATAndrew Twinamatsiko noted the ruling 'pointed out how much authority they think the Secretary wields — which is kind of foreboding given who the Secretary is and his ideas about science and health.'

RFK Jr. had already demonstrated his approach to scientific advisory bodies: in May 2025, he dismissed all 17 members of the CDC's Advisory Committee on Immunization Practices (ACIP) — the body whose vaccine recommendations determine what vaccines insurers must cover and what children must receive for school enrollment — and replaced them with nine new members, several of whom share his skepticism about vaccine safety. ACIP had been meeting regularly since 1964. The firings triggered lawsuits. After the Braidwood ruling, health policy experts warned the same approach — firing the USPSTF and installing aligned replacements who would recommend against PrEP, certain cancer screenings, or other politically disfavored services — was now legally authorized. HHS also postponed a USPSTF meeting scheduled for July 10, 2025, one day after the Braidwood ruling.

The dissenters — Thomas, Alito, and Gorsuch — would have gone the other direction entirely and ruled the USPSTF unconstitutional, requiring a full rebuild of the ACA preventive services framework with Senate-confirmed members. Their approach would have been more protective of USPSTF's independence by requiring political accountability through confirmation — but it would also have eliminated the existing coverage mandate while Congress reconstructed the system, creating a gap potentially affecting millions of Americans. The dissenters' position was internally inconsistent in this respect: greater constitutional formalism about appointments would have produced less coverage protection in practice.