Supreme Court Upholds ACA No-Cost Preventive Care Mandate

In a 6-3 decision issued on June 27, the Supreme Court upheld the Affordable Care Act’s (ACA’s) requirement that health insurance plans cover services recommended by the U.S. Preventive Services Task Force (USPSTF) at no cost to the covered individual. Such services include cancer screenings, pregnancy care, testing for sexually transmitted diseases, and pre-exposure prophylaxis (“PrEP”) antiretroviral medication to prevent the spread of HIV.  

Case Background

Under the ACA, employer health plans and individual health plans are required to cover the above services without imposing cost-sharing obligations on the covered individual. It is the responsibility of the USPSTF to determine which services are regarded as preventive.  

Toolkit: Complying with the Affordable Care Act

In Kennedy v. Braidwood Management, the defendant, a Christian-owned business, objected to providing said services without cost-sharing. Religious employers such as Braidwood argue that being forced to cover birth control or HIV prevention violates their religious liberty under the First Amendment. However, Braidwood also argued that the USPSTF, which is appointed by the secretary of Health and Human Services (HHS) without Senate confirmation, is not legally able to make preventive service recommendations.  

Last year, the 5th U.S. Circuit Court of Appeals held that the members of the task force were not constitutionally appointed, meaning that any of their preventive care recommendations would not be required to be covered without cost-sharing.  

Ruling Affirms Task Force’s Authority

In its decision, the Supreme Court rejected the lower court’s ruling that the USPSTF must be appointed by the president and approved by the Senate. In the opinion delivered by Justice Brett Kavanaugh, the court held that the “Task Force members are inferior officers whose appointment by the Secretary of HHS is consistent with the Appointments Clause.” 

Kavanaugh explained that the Appointments Clause in Article II of the Constitution divides all officers into two classes. While principal officers must be appointed by the president “with the Advice and Consent of the Senate,” inferior officers may be appointed by the president, the courts, or the heads of departments. Kavanaugh clarified that inferior officers are those “whose work is directed and supervised at some level by others who were appointed by Presidential nomination,” as established in the court’s 1997 ruling in Edmond v. United States. Hence, the USPSTF members are considered inferior officers supervised by the secretary of HHS, who is a principal officer.  

“The Task Force members are removable at will by the Secretary of HHS, and their recommendations are reviewable by the Secretary before they take effect,” Kavanaugh said. Thus, “Task Force members are supervised and directed by the Secretary, who in turn answers to the President, preserving the chain of command in Article II.”  

Kavanaugh concluded his opinion by stating that the court “reverse[s] the judgment of the Court of Appeals and remand[s] the case for further proceedings consistent with this opinion.”  

Justice Clarence Thomas issued a dissenting opinion, in which he argued that the court’s decision “distorts Congress’s design for the Task Force, changing it from an independent body that reports directly to the President to one subject to the control of the Secretary of HHS.”

Though the court’s decision focused principally on the authority of the USPSTF, it has far-reaching consequences for the ACA and employer health plans. By affirming the task force’s power to determine preventive care services, the court has effectively rejected cost-sharing for certain preventive services. Health plans, including those of Christian-owned businesses such as Braidwood, will continue to be required to cover these preventive services without cost-sharing.