The Supreme Court upheld the authority of the Secretary of Health and Human Services (HHS) to appoint members of the U.S. Preventive Services Task Force, rejecting claims that the current appointment process violates the Constitution’s Appointments Clause on Friday.

The U.S. Preventive Services Task Force, established in 1984 and codified by Congress in 1999, is a panel of 16 volunteer medical experts that issues evidence-based recommendations on preventive healthcare services. Under the Affordable Care Act (ACA) of 2010, many of the Task Force’s “A” and “B” recommendations became binding, requiring most health insurers to cover those services without cost-sharing.

Plaintiffs in the case, led by Braidwood Management, challenged the legality of the Task Force’s structure. They argued that its members are “principal officers” under the Constitution, who must be nominated by the President and confirmed by the Senate, rather than appointed by the HHS Secretary. Lower courts agreed with the plaintiffs, finding the appointment process unconstitutional and enjoining enforcement of Task Force recommendations against the plaintiffs.

In a 6-3 decision authored by Justice Kavanaugh, the Supreme Court reversed the lower courts. The majority held that Task Force members are “inferior officers” whose appointment by the HHS Secretary is consistent with the Appointments Clause.

The Court’s reasoning centered on two main points:

• Supervision and Removal: The Secretary of HHS has the authority to remove Task Force members at will, a “powerful tool for control” that ensures they are directed and supervised by a principal officer.
• Review Authority: The Secretary also has statutory authority to review and block Task Force recommendations before they take effect, further reinforcing the Secretary’s supervisory power.

The Court found that this structure mirrors longstanding models within the executive branch, where inferior officers make initial decisions subject to review by politically accountable superiors. The majority rejected arguments that statutory language describing the Task Force as “independent” created for-cause removal protections or insulated the panel from oversight.

Addressing concerns about whether Congress had properly vested appointment authority in the Secretary, the Court concluded that a combination of statutes, the 1999 law empowering the AHRQ Director to “convene” the Task Force and a 1966 reorganization plan transferring agency functions to the Secretary, together give the Secretary appointment power. Since June 2023, the Secretary has exercised this power directly, ratifying and reappointing Task Force members.

Justice Thomas, joined by Justices Alito and Gorsuch, dissented. The dissent argued that Congress had not clearly vested appointment authority in the Secretary and that the majority’s reading distorted both the statutory text and the constitutional principle of democratic accountability.