Supreme Court Upholds the ACA Preventive Services Mandate

On June 27, 2025, the United States Supreme Court decided Kennedy v. Braidwood Management, Inc., upholding the Affordable Care Act’s (“ACA”) requirement that non-grandfathered group health plans cover certain preventive services without cost-sharing based on “A” or “B” recommendations made by the U.S. Preventive Services Task Force (“Task Force”).

Plaintiffs, individuals and small businesses who objected to the ACA’s preventive services coverage requirements, argued that Task Force members are principal officers under the Appointments Clause of the Constitution, requiring appointment by the President and confirmation by the Senate. Previously, the Fifth Circuit had enjoined the government from enforcing the Task Force’s “A” or “B” recommendations made on or after March 23, 2010, against the plaintiffs.

The Supreme Court’s decision reversed the Fifth Circuit and confirmed the continued enforceability of all the Task Force’s “A” and “B” recommendations. The case was formerly known as Braidwood Management, Inc. v. Becerra.

“Preventive Care” Under the ACA

The ACA imposes preventive services mandates on non-grandfathered group health plans and private insurers (“health plans”). The ACA amended Section 2713 of the Public Health Services Act to require health plans to provide coverage for “preventive care” without “cost sharing,” meaning without deductibles, copayments, or other out-of-pocket expenses. Instead of defining “preventive care,” the ACA delegates to administrative bodies the authority to determine what services constitute preventive care. There are three administrative bodies tasked with issuing or recommending preventive care mandates: the Advisory Committee on Immunization Practices (“ACIP”); the Health Resources and Services Administration (“HRSA”); and the Task Force.

Specifically, the ACA mandates that non-grandfathered health plans cover four categories of preventive services without cost-sharing:

1. Task Force-rated “A” or “B” evidence-based items and services (these recommendations can be viewed here);
2. Immunization recommendations by ACIP;
3. HRSA-supported evidence-based guidelines for infants, children, and adolescents; and
4. HRSA Women’s Preventive Services Guidelines.

U.S. Preventive Services Task Force

The Task Force is composed of 16 volunteer experts who serve staggered four-year terms. The ACA modified the statute that created the Task Force to provide that members of the Task Force must be “convene[d]” by the Director of the Agency for Healthcare Research and Quality (“AHRQ”), an entity within the Department of Health and Human Services (“HHS”). Until June 2023, the Director of AHRQ appointed every member of the Task Force. Following the plaintiffs’ challenge of this structure, the Secretary of HHS, Xavier Becerra, sought to ratify all the Director’s previous appointments to the Task Force made before June 2023. Since then, the Secretary of HHS has personally appointed each member of the Task Force.

The ACA directs the Secretary of HHS to “establish a minimum interval,” not less than one year, before the Task Force’s “A” or “B” recommendations take effect. The ACA also amended the statute governing the Task Force to provide that the members of the Task Force and their recommendations must be “independent and, to the extent practicable, not subject to political pressure.”

Fifth Circuit Reversed District Court’s Nationwide Injunction

In 2020, Braidwood Management and other plaintiffs challenged this statutory scheme, arguing that Task Force members are principal officers who must be nominated by the President and confirmed by the Senate, rendering unlawful all post-March 23, 2010 “A” or “B” recommendations by the Task Force. The U.S. District Court for the Northern District of Texas (“District Court”) agreed with the plaintiffs and vacated all agency actions taken to enforce the Task Force’s mandates and issued a nationwide injunction.

On appeal, the Fifth Circuit ruled that the Task Force’s “unreviewable” power to issue preventive services mandates renders its members principal officers of the United States. The Fifth Circuit reasoned that because the Task Force’s members were not properly appointed under the Appointments Clause of the Constitution, the preventive services mandates that followed could not be enforced against the plaintiffs. Despite siding with the plaintiffs, the Fifth Circuit reversed both the District Court’s nationwide injunction and its invalidation of all agency actions to enforce the mandates at issue.

Supreme Court Upholds Preventive Services Mandate

At the Supreme Court, the issue was whether appointment of Task Force members by the Secretary of HHS was consistent with the Appointments Clause in Article II of the Constitution. The issue turned on whether the Task Force members are principal officers or inferior officers.

The Supreme Court held that Task Force members are inferior officers whose appointment by the Secretary of HHS is consistent with the Appointments Clause. Inferior officers are those whose work is directed and supervised by others who were appointed by the President with the advice and consent of the Senate. Inferior officers may be appointed by Presidential nomination and Senate confirmation, but Congress may also “vest” their appointment in the President, courts of law, or in department heads.

The court reasoned that Task Force members are inferior officers because their work is “directed and supervised” by the Secretary of HHS for two reasons: (1) the Secretary has the authority to remove the members at will; and (2) the Secretary has the statutory authority to directly review and “block” Task Force recommendations before they take effect.

The court reasoned that Congress has vested appointment authority in the Secretary of HHS through two steps: (1) a 1999 statute governing the Task Force gives the AHRQ Director the authority to “convene” a Task Force; and (2) in 1984, Congress ratified Reorganization Plan No. 3 of 1966, which transfers all of the AHRQ Director’s functions to the Secretary of HHS. Through the combination of these two acts, Congress vested the power to appoint Task Force members in the Secretary of HHS.

The court held that since June 2023—when the Secretary ratified the prior appointments made by the Director of AHRQ—the Secretary has properly exercised his appointment authority. As a result, non-grandfathered health plans must continue to provide first-dollar coverage for all items or services that receive an “A” or “B” rating by the Task Force.

If you have any questions about the impact of the Supreme Court’s ruling or preventive services coverage requirements please contact a member of the Miller Johnson Employee Benefits & Executive Compensation practice group.