U.S. Supreme Court Upholds Key ACA Preventive Care Mandate: What Employers Need to Know

June 30, 2025

Overview

On June 27, 2025, the U.S. Supreme Court issued a highly anticipated decision in Kennedy, Secretary of Health and Human Services, et al. v. Braidwood Management, Inc., et al. affirming a core component of the Affordable Care Act (“ACA”) that requires health insurance issuers and plans to cover certain preventive services at no cost to the individual.

The 6-3 ruling means that services like cancer screenings, immunizations, and many other crucial preventive measures will continue to be covered in full, without out-of-pocket costs for individuals. Thus, ensuring access to essential healthcare for millions of Americans.

The case primarily centered on a constitutional challenge to the U.S. Preventive Services Task Force (“USPSTF”), the independent body responsible for recommending “A” and “B” rated preventive services. The Court specifically addressed and overturned a lower court’s ruling that had challenged the authority of the USPSTF, clarifying that the Task Force’s appointment and recommendations are valid under the Constitution.

Action Items

• Preventive Services Benefits – Status Quo: For most employers, this Supreme Court decision means business as usual. Health plans must continue to cover preventive services as they have been. Individuals will continue to have access to a wide range of preventive services, such as cancer screenings, diabetes screenings, blood pressure screenings, and HIV prevention medications (like PrEP), without out-of-pocket costs.
• Focus on Communication and Engagement: Employers should use this opportunity to educate participants about the availability and importance of preventive services. Remind participants to utilize these no-cost benefits for their well-being. Take this opportunity to remind participants about the availability of no-cost preventive care services under the employer group health plan and encourage them to utilize these services for their well-being.
• Review Plan Documents (if applicable): For self-funded plans, ensure the plan documents accurately reflect the requirement to cover preventive services without cost-sharing. Fully insured plans should defer to their insurance carrier.
• Stay Informed on Future Developments: While this specific challenge to the USPSTF’s authority under the Appointments Clause has been resolved, the healthcare landscape is constantly evolving. Employers should remain aware of any future legislative or judicial actions that may impact the ACA and/or employer-sponsored health plans.

Summary

The ACA’s Preventive Care Mandate, enacted in 2010, requires health insurance issuers and most non-grandfathered health plans to cover a specific set of recommended preventive services without out-of-pocket costs (deductibles, copayments, or coinsurance) when provided by in-network providers. This ensures that a financial burden does not prevent individuals from accessing crucial screenings, vaccinations, and other preventive care. These services include recommendations from the USPSTF with “A” or “B” ratings, immunizations recommended by the Advisory Committee on Immunization Practices (“ACIP”), and preventive care guidelines for children, adolescents, and women supported by the Health Resources and Services Administration (“HRSA”).

The Supreme Court case, Kennedy, Secretary of Health and Human Services, et al. v. Braidwood Management, Inc., et al., challenged this mandate. The plaintiffs, primarily Christian-owned businesses and individuals challenged the requirements. While some initial arguments involved religious objections to covering certain services like HIV-prevention related medication, the specific issue that reached the Supreme Court centered on the “Appointments Clause” of the U.S. Constitution.

The Appointments Clause dictates how “Officers of the United States” must be appointed. There are two main types: (a) principal officers; and (b) inferior officers. Principal officers require Presidential nomination and Senate confirmation, whereas inferior officers are appointed by “Heads of Departments.”

The plaintiffs argued that the members of the USPSTF were “principal officers” because their recommendations (specifically those with an “A” or “B” rating) effectively become law, requiring health plans to cover those services without cost-sharing. Since USPSTF members are not nominated by the President and confirmed by the Senate, the plaintiffs contended their appointments were unconstitutional, and therefore, their recommendations should not be legally binding.

In March 2023, a lower court initially agreed, issuing a nationwide injunction. The District Court’s central opinion was that the preventive care coverage requirements based on the USPSTF’s “A” or “B” ratings did violate the Appointments Clause. The court affirmed members of the USPSTF, who are volunteers with expertise in preventive medicine, were “principal officers” of the federal government and, as such, should have been nominated by the President and confirmed by the Senate. Since this was not the case, the court ruled their appointments unconstitutional. This ruling was significant because it potentially struck down a wide range of preventive services that had been mandated for coverage. The nationwide injunction would have prohibited the federal government from enforcing these mandates against any health plans or issuers across the country.

The Biden administration appealed this decision to the 5th U.S. Circuit Court of Appeals; whereupon the Fifth Circuit offered a mixed ruling. The court largely agreed with the district court that the USPSTF’s appointment structure was problematic, but it limited the scope of the relief, applying it only to the specific plaintiffs in the case rather than issuing a nationwide injunction. This meant that for most Americans with private health insurance, the no-cost preventive services mandate remained in effect while the case made its way to the Supreme Court.

On June 27, 2025, the Supreme Court reversed the lower court’s ruling, holding 6-3 that USPSTF members are “inferior officers” because their work is supervised and can be reviewed and overridden by the Secretary of Health and Human Services (“HHS”), who also has the power to remove them at will. This decision upholds the ACA’s preventive care mandate, ensuring health plans continue to cover these essential services without cost-sharing.

The majority opinion, authored by Justice Brett Kavanaugh, reasoned that the USPSTF members qualify as “inferior officers” because their work is “directed and supervised” by the Secretary of HHS. Key to this determination were two main points:

1. At-will Removal: The Secretary of HHS has the power to remove USPSTF members at will (meaning they can be fired without specific cause). This level of control signifies that they are not independent principal officers.
2. Secretary’s Review Authority: The Secretary of HHS also has the statutory authority to review and even block USPSTF recommendations before they take effect. This supervisory power further cemented their status as “inferior officers” accountable to a principal officer (the Secretary).

The minority (Justices Thomas, Gorsuch, and Alito) dissented, arguing the Supreme Court should have fully resolved the Appointments Clause issue regarding the USPSTF before sending the case back to the 5th Circuit Court of Appeals for further proceedings

As a direct result of this ruling, the ACA’s preventive care mandate remains fully intact and enforceable. This means that employer-sponsored health plans and health insurance issuers are legally required to continue covering the entire range of recommended preventive care services without imposing cost-sharing requirements on their members. This ruling provides clarity and stability for employers, plan administrators, and, most importantly, the millions of individuals who rely on these services for their health and well-being.

Additional Information & Related Resources

Supreme Court Opinion – Kennedy v. Braidwood

For questions regarding this Alert or any other related compliance issues, please contact the Baldwin Regulatory Compliance Collaborative.  

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Kindest regards,
Baldwin Regulatory Compliance Collaborative