The U.S. Supreme Court has issued a 6–3 decision upholding the constitutionality of an advisory panel that chooses the benefits to be included in the Affordable Care Act's preventive benefits package. In the majority opinion authored by Justice Brett Kavanaugh, the court held that Robert F. Kennedy, Jr., Secretary of the U.S. Department of Health and Human Services (HHS), has sufficient authority over the U.S. Preventive Services Task Force (USPSTF) to avoid a violation of the U.S. Constitution's appointment clause. The majority opinion characterizes the task force members as "inferior officers" properly appointed by the authority that Congress has given the HHS Secretary.
Chief Justice John Roberts, Sonia Sotomayor, Elena Kagan, Amy Coney Barrett and Ketanji Brown Jackson join in the majority opinion in Kennedy, Secretary of Health and Human Services, et al. v. Braidwood Management, Inc. et al., 606 U.S. ______ (2025). The high Court's ruling overturns a June 2024 ruling by the U.S. Court of Appeals for the Fifth Circuit.
The Braidwood decision preserves the USPSTF's recommendations, allowing preventive services that are free of charge to remain part of the ACA's core benefits package. Furthermore, the USPSTF has the power to continue advising HHS to shape the package. The ACA requires all non-grandfathered providers of major medical coverage to pay for certain preventive services without holding patients responsible for co-payments, coinsurance amounts, or deductibles.
The USPSTF is not the only advisory panel that the HHS relies on to contribute to the ACA preventive care package. While the USPSTF makes recommendations on items such as diabetes and cancer screenings, a second panel chooses vaccines, and a third panel chooses items related to women's and children's health.
Braidwood Management is a Texas company that provides direct medical services to patients under the direction of Dr. Steven Hotze. In 2020, Braidwood filed suit challenging the constitutionality of the USPSTF under the Appointments Clause, which requires all U.S. government officers to either be elected or confirmed by the Senate.
After four years of litigation, the Supreme Court considered whether the congressionally-created structure of the USPSTP, which was designed to be independent, violated the U.S. Constitution. According to Braidwood, any panel members issuing independent advice should have Senate confirmation. Kennedy maintained that since he has control over USPSTP and the right to terminate panel members, the structure of USPSTP is constitutional.
A majority of the Supreme Court agreed with Kennedy, stating that the ability of "inferior officers" like USPSTP members can express their views without running afoul of the appointments clause. Although USPSTP can make final recommendations that are not reviewable or appealable, Kennedy can review the recommendations and prevent them from taking effect. The majority also pointed out that an inferior officer is not defined by whether a principal officer can force a subordinate to take affirmative action in a way that affects private parties. Like USPSTP members, the Supreme Court has classified patent judges, Coast Guard judges, and Public Company Accounting Oversight Board members as inferior officers. The Court decided to classify them because they are removable at will, and superior officers can reverse their decisions, even if inferior officers initially make decisions free from the influence of supervisors.
Justice Clarence Thomas, joined by Justices Neil Gorsuch and Samuel Alito, issued a dissenting opinion in which he states that the Court should have decided the appointment clause question and remanded the case back to the Fifth Circuit for its consideration. The dissenting opinion also characterizes the Court's majority opinion as in direct conflict with the appointments clause and how Congress intended the USPSTP to operate.
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