Supreme Court upholds Affordable Care Act’s preventive care mandate

WASHINGTON – The U.S. Supreme Court on Friday upheld a portion of the Affordable Care Act that requires health plans to provide free preventive care such as screenings for cancer and HIV.

In a 6-3 decision, the justices ruled against a Christian-owned business and individuals who objected to being forced to offer medications intended to prevent the spread of HIV among people at risk. The plaintiffs contend the pre-exposure prophylaxis (PrEP) treatment administered to prevent infections, “encourage and facilitate homosexual behavior” in conflict with their religious beliefs.

Health care providers and nonprofit organizations said the case, Kennedy v. Braidwood, could have blocked critical health care for many Americans. A Stanford University study estimated nearly 40 million Americans use the act’s preventive services.

The preventive care mandate covers dozens of services – from statins to prevent heart disease to screenings for hepatitis B and HIV. The legal challenge had threatened to hamper access to PrEP, which HIV experts see as necessary to stymie one of the world’s most rampant infectious diseases.

Friday’s ruling was one of five opinions from the justices on the final day of the Supreme Court term. A sixth case was sent for reconsideration next term.

The groups objected to the preventive care mandate on religious grounds, but their legal arguments before the high court involved a technical question about the expert panel that decides which measures health plans must cover.

They argued that members of the Preventive Services Task Force were improperly appointed because they were not approved by the Senate. The mandate, the challengers said, was therefore unenforceable. The high court rejected that argument.

The health and human services secretary, since 2023, has made appointments to the preventive care panel.

“Task Force members issue preventive services recommendations of critical importance to patients, doctors, insurers, employers, healthcare organizations, and the American people more broadly,” Justice Brett M. Kavanaugh wrote for the majority. “In doing so, however, the Task Force members remain subject to the Secretary of HHS’s supervision and direction, and the Secretary remains subject to the President’s supervision and direction.”

Public health groups on Friday hailed the decision but also worried it may prove a double-edge sword under Trump administration health officials who have rejected long-standing public health guidance.

The opinion paves the way for HHS Secretary Robert F. Kennedy Jr., a prominent anti-vaccine activist, and his successors to exert greater control over the panel’s recommendations, said Jose Abrigo, HIV Project Director of the Lambda Legal Defense and Education Fund, an LGBTQ+ legal advocacy organization.

Kennedy recently fired all the members of a key vaccine recommendation panel, replacing them with allies who plan to reexamine long-settled practices on childhood immunization. Like the task force at issue in the Braidwood case, the vaccine committee’s recommendations compel insurers to pay for preventive services.

“The ruling now invites the secretary to cherry-pick future recommendations – and past recommendations,” Abrigo said. “The decision could undermine the autonomy of the task force. Politics should not be injected into medicine.”

The Constitution’s appointment clause requires the president to appoint and win Senate approval for principal officers such as Cabinet secretaries, federal judges and ambassadors but allows Congress to vest authority in department heads and other officials to appoint “inferior officers.”

Jonathan Mitchell, an attorney for the challengers, said during oral arguments in April that the 16-member task force wields significant independent power and its appointees therefore should be considered principal officers.

Lawyers defending President Donald Trump in his classified documents case last year made a similar argument about special counsel Jack Smith, and convinced a federal judge appointed by Trump in his first term to toss the indictment.

Conservative justices Clarence Thomas, Samuel A. Alito Jr. and Neil M. Gorsuch dissented. In his dissenting opinion, Thomas argued that Congress enacted a task force subject to the president’s control, not the HHS secretary.

Ilya Shapiro, a senior fellow and director of constitutional studies at the Manhattan Institute, a conservative think tank, called the decision disappointing. “This ruling can’t help but further entrench the unaccountable bureaucracy that increasingly sets the rules by which we live our daily lives,” he said in a statement.