The Supreme Court upholds free preventive care, but its future now rests in RFK Jr.’s hands
- Written by Paul Shafer, Associate Professor of Health Law, Policy and Management, Boston University
On June 26, 2025, the U.S. Supreme Court handed down a 6-3 ruling[1] that preserves free preventive care[2] under the Affordable Care Act, a popular benefit that helps approximately 150 million Americans[3] stay healthy.
The case, Kennedy v. Braidwood, was the fourth major legal challenge[4] to the Affordable Care Act. The decision, written by Justice Brett Kavanaugh with the support of Justices Amy Coney Barrett, Elena Kagan, Ketanji Brown Jackson and Sonia Sotomayor, ruled that insurers must continue to cover at no cost any preventive care approved by a federal panel called the U.S. Preventive Services Task Force[5].
Members of the task force are independent scientific experts, appointed for four-year terms[6]. The panel’s role had been purely advisory[7] until the ACA, and the plaintiffs contended that the members lacked the appropriate authority as they had not been appointed by the President and confirmed by the Senate. The Supreme Court rejected this argument, saying that members simply needed to be appointed by[8] the Health and Human Services Secretary – currently, Robert F. Kennedy Jr. – which they had been, under his predecessor during the Biden administration.
This ruling seemingly safeguards access to preventive care. But as public health researchers who study health insurance[9] and sexual health[10], we see another concern: It leaves preventive care vulnerable to how Kennedy and future HHS secretaries will choose to exercise their power[11] over the task force and its recommendations.
What is the US Preventive Services Task Force?
The U.S. Preventive Services Task Force[12] was initially created in 1984 to develop recommendations about prevention for primary care doctors. It is modeled after the Canadian Task Force on Preventive Health Care, which was established in 1976.
The task force makes new recommendations and updates existing ones[14] by reviewing clinical and policy evidence on a regular basis and weighing the potential benefits and risks of a wide range of health screenings and interventions. These include mammograms; blood pressure, colon cancer, diabetes and osteoporosis screenings; and HIV prevention. Over 150 million Americans[15] have benefited from free coverage of these recommended services under the ACA, and around 60% of privately insured people[16] use at least one of the covered services each year.
The task force plays such a crucial role in health care because it is one of three federal groups whose recommendations insurers must abide by. Section 2713[17] of the Affordable Care Act requires insurers to offer full coverage of preventive services[18] endorsed by three federal groups: the U.S. Preventive Services Task Force, the Advisory Committee on Immunization Practices, and the Health Resources and Services Administration. For example, the coronavirus relief bill[19], which passed in March 2020 and allocated emergency funding in response to the COVID-19 pandemic, used this provision to ensure COVID-19 vaccines would be free[20] for many Americans.
The Braidwood case and HIV prevention
This case, originally filed in Texas in 2020, was brought by Braidwood Management[21], a Christian for-profit corporation owned by Steven Hotze[22], a Texas physician and Republican activist who has previously filed multiple lawsuits against the ACA. Braidwood and its co-plaintiffs argued on religious grounds against being forced to offer preexposure prophylaxis, or PrEP, a medicine that prevents HIV infection, in their insurance plans.
At issue in Braidwood was whether task force members – providers and researchers who provide independent and nonpartisan expertise – were appropriately appointed and supervised under the appointments clause[23] of the Constitution, which specifies how various government positions are appointed. The case called into question free coverage of all recommendations made by the task force[24] since the Affordable Care Act was passed in March 2010.
In the ruling, Kavanaugh wrote that “the Task Force members’ appointments are fully consistent with the Appointments Clause in Article II of the Constitution.” In laying out his reasoning, he wrote, “The Task Force members were appointed by and are supervised and directed by the Secretary of HHS. And the Secretary of HHS, in turn, answers to the President of the United States.”
Concerns over political influence
The U.S. Preventive Services Task Force is meant to operate independently of political influence, and its decisions are technically not directly reviewable. However, the task force is appointed by the HHS secretary, who may remove any of its members at any time for any reason, even if such actions are highly unusual.
Kennedy recently took the unprecedented step of removing all members[25] of the Advisory Committee on Immunization Practices, which debates vaccine safety but also, crucially, helps decide what immunizations are free to Americans guaranteed by the Affordable Care Act. The newly constituted committee, appointed in weeks rather than years[26], includes several vaccine skeptics[27] and has already moved to rescind some vaccine recommendations, such as routine COVID-19 vaccines for pregnant women and children[28].
Kennedy has also proposed restructuring out of existence[29] the agency that supports the task force[30], the Agency for Healthcare Research and Quality. That agency has been subject to massive layoffs[31] within the Department of Health and Human Services. For full disclosure, one of the authors is currently funded by the Agency for Healthcare Research and Quality and previously worked there.
The decision to safeguard the U.S. Preventive Services Task Force as a body and, by extension, free preventive care under the ACA, doesn’t come without risks and highlights the fragility of long-standing, independent advisory systems in the face of the politicization of health. Kennedy could simply remove the existing task force members and replace them with members who may reshape the types of care recommended to Americans by their doctors and insurance plans based on debunked science[32] and misinformation[33].
Partisanship and the politicization of health threaten trust in evidence. Already, signs are emerging that Americans on both side of the political divide are losing confidence[34] in government health agencies. This ruling preserves a crucial part of the Affordable Care Act, yet federal health guidelines and access to lifesaving care could still swing dramatically in Kennedy’s hands – or with each subsequent transition of power.
Portions of this article originally appeared in previous articles published on Sept. 7, 2021[35]; Dec. 1, 2021[36]; Sept. 13, 2022[37]; April 7, 2023[38]; and April 15, 2025[39].
References
- ^ 6-3 ruling (www.supremecourt.gov)
- ^ free preventive care (www.kff.org)
- ^ 150 million Americans (aspe.hhs.gov)
- ^ fourth major legal challenge (theconversation.com)
- ^ U.S. Preventive Services Task Force (www.uspreventiveservicestaskforce.org)
- ^ four-year terms (www.ahrq.gov)
- ^ purely advisory (www.supremecourt.gov)
- ^ members simply needed to be appointed by (slate.com)
- ^ health insurance (www.bu.edu)
- ^ sexual health (sph.tulane.edu)
- ^ exercise their power (theconversation.com)
- ^ The U.S. Preventive Services Task Force (www.uspreventiveservicestaskforce.org)
- ^ SDI Productions/E+ via Getty Images (www.gettyimages.com)
- ^ makes new recommendations and updates existing ones (www.uspreventiveservicestaskforce.org)
- ^ 150 million Americans (aspe.hhs.gov)
- ^ 60% of privately insured people (www.healthsystemtracker.org)
- ^ Section 2713 (www.law.cornell.edu)
- ^ full coverage of preventive services (www.healthcare.gov)
- ^ the coronavirus relief bill (www.congress.gov)
- ^ ensure COVID-19 vaccines would be free (www.kff.org)
- ^ Braidwood Management (kffhealthnews.org)
- ^ Steven Hotze (www.texastribune.org)
- ^ appointments clause (www.law.cornell.edu)
- ^ all recommendations made by the task force (jamanetwork.com)
- ^ removing all members (theconversation.com)
- ^ weeks rather than years (www.scientificamerican.com)
- ^ several vaccine skeptics (www.nytimes.com)
- ^ COVID-19 vaccines for pregnant women and children (theconversation.com)
- ^ restructuring out of existence (kffhealthnews.org)
- ^ supports the task force (www.ahrq.gov)
- ^ massive layoffs (theconversation.com)
- ^ debunked science (theconversation.com)
- ^ misinformation (theconversation.com)
- ^ are losing confidence (www.kff.org)
- ^ Sept. 7, 2021 (theconversation.com)
- ^ Dec. 1, 2021 (theconversation.com)
- ^ Sept. 13, 2022 (theconversation.com)
- ^ April 7, 2023 (theconversation.com)
- ^ April 15, 2025 (theconversation.com)
Authors: Paul Shafer, Associate Professor of Health Law, Policy and Management, Boston University
