The U.S. Supreme Court has upheld the federal government’s authority to require most health insurers to cover a broad range of preventive care services without cost-sharing, preserving a key provision of the Affordable Care Act (ACA) that has expanded access to screenings, medications, and other measures for millions of Americans.
At the center of the decision was the U.S. Preventive Services Task Force (USPSTF), a panel of medical experts whose recommendations determine which preventive services must be covered by insurers at no charge to patients. Since the ACA’s passage in 2010, services rated “A” or “B” by the Task Force — including cancer screenings, cholesterol tests, and preventive medications — have been available to insured Americans without copays or deductibles.
The case, Kennedy v. Braidwood Management, Inc., was brought by individuals and small businesses who objected to the ACA’s preventive-services coverage requirements. They argued that the members of the USPSTF were “principal officers” under the Constitution’s Appointments Clause and, therefore, should have been appointed by the President and confirmed by the Senate, rather than by the Secretary of Health and Human Services (HHS).
Lower courts sided with the plaintiffs, raising the prospect that the mandate for insurers to cover preventive care could be struck down, potentially affecting coverage for dozens of services relied upon by Americans.
In a 6-3 decision, the Supreme Court reversed the lower courts, holding that USPSTF members are “inferior officers” whose appointment by the HHS Secretary is constitutionally valid. Writing for the majority, Justice Kavanaugh explained that Task Force members are subject to supervision and removal by the Secretary, who in turn answers to the President, preserving the chain of accountability required by the Constitution.
The Court also clarified that the Secretary of HHS has the authority to review and block Task Force recommendations before they become binding, further supporting the conclusion that Task Force members are not principal officers.
This ruling ensures that the ACA’s requirement for insurers to cover preventive services rated “A” or “B” by the USPSTF remains intact. More than 40 preventive services are currently covered under this mandate, including:
- Screenings for lung, breast, cervical, and colorectal cancer
- Diabetes and cholesterol screenings
- Statin medications to reduce heart disease risk
- Nicotine replacement therapies for smoking cessation
- Preventive medications for women at high risk of breast cancer
- Physical therapy to prevent falls in the elderly
These services must be provided without copayments, deductibles, or other cost-sharing, making them accessible to millions of Americans and supporting public health goals such as early detection and chronic disease prevention.
