On Friday, June 27, 2025, the Supreme Court reversed the Fifth Circuit’s ruling in Kennedy et al v. Braidwood Management, Inc. et al, concluding that members of the U.S. Preventative Services Task Force (USPSTF) are appropriately appointed “inferior officers” of the United States. This finding upholds the current process by which the USPSTF makes recommendations for insurance coverage requirements under the Affordable Care Act (ACA) and – most importantly – confirms the Department of Health and Human Services (HHS) secretary’s ability to review and block preventive services recommendations before they become binding.
While the Court may have turned a spotlight on the HHS secretary’s review, it did not create new powers of oversight – only confirmed them. However, the ruling has prompted some concern that it will empower Robert F. Kennedy Jr. (RFK) to advance recommendations in line with his public health agenda or, conversely, block those that conflict with the Trump administration’s policy perspectives. As HHS secretary, RFK has oversight over the USPSTF and other influential public health panels, as exemplified by his recent (and controversial) restaffing of the Advisory Committee on Immunization Practices. Whether he chooses to exercise those powers to advance preventive care recommendations in line with his “Make America Healthy Again” agenda remains to be seen.
Braidwood: Background and SCOTUS decision
Collectively filed in 2020 by Braidwood Management, Kelley Orthodontics, and several individuals in Texas, Braidwood is a constitutional objection to the ACA’s requirement that private health insurance plans cover preventive services recommended by the USPSTF without imposing cost-sharing obligations. The plaintiffs contended that the USPSTF’s structure and appointment process violated the Appointments Clause of the Constitution, alleging that the task force operated with unconstitutional independence and insufficient supervision. As such, they sought to prevent the government from enforcing all ACA coverage requirements based on recommendations made after March 23, 2010.
The plaintiffs prevailed in district and appellate court, both of which found the USPSTF’s appointment process unconstitutional and enjoined enforcement of the relevant ACA requirements – though the Fifth Circuit limited that relief to the plaintiffs, rather than applying it nationwide. The Supreme Court was more skeptical, with several justices expressing their doubts even during the plaintiff’s oral arguments. In its June 27 decision, the Court formally rejected the plaintiff’s claims that the task force operates without sufficient oversight, noting that the HHS secretary:
- May provide feedback during a period of “not less than one year” after new recommendations are introduced
- Can request the reconsideration or withdrawal of a recommendation
- Can remove and replace task force members who refuse to adhere to feedback
- Can ultimately ensure that no recommendation contrary to HHS secretary’s judgment becomes binding
The Court emphasized that the secretary’s ability to both remove USPSTF members at will and veto the implementation of their recommendations constitutes a “powerful tool for control,” confirming that the secretary has ultimate responsibility for which recommendations apply under the ACA. This level of supervision and control, the Court reasoned, would suggest that USPSTF members are not “principal officers” – who would require presidential nomination and Senate confirmation – but rather “inferior officers” whose appointments can be vested in the head of a department (e.g., the HHS secretary). The Court also clarified that Congress, through a combination of statutes and reorganization plans, had properly vested the appointment authority in the HHS secretary. The secretary’s actions since June 2023 (e.g., personally appointing and ratifying the appointments of USPSTF members) were found to be constitutionally valid.
To summarize: The Supreme Court has confirmed that the HHS secretary has broad authority to appoint and remove USPSTF members at will, as well as delay (or outright reject) proposed preventative care requirements before they become binding on health plans.
Implications and recommendations for health plans
The Supreme Court’s decision in Braidwood should not have any immediate implications for health plans, as it simply preserves privately insured Americans’ access to independently recommended preventative services without cost-sharing. However, how RFK will choose to exercise the HHS secretary’s sweeping authority over HHS public policy panels remains to be seen.
For now, managed care organizations (MCOs) should proceed as usual. The Supreme Court’s decision in Braidwood upholds the status quo; the task force will operate normally, and health plans should continue to comply with ACA preventative care requirements by including coverage for USPSTF-recommended services without imposing member cost-sharing requirements. In the longer term, MCOs will need to stay tuned for any news on how RFK plans to influence the USPSTF’s recommendations following the Court’s decision.
Client Alert 2025-171
