The Supreme Court is set to hear oral arguments in a pivotal case involving the constitutionality of the structure of the U.S. Preventive Services Task Force, an independent expert panel within the Department of Health and Human Services (HHS). The task force is responsible for determining which “preventive health services” must be covered by insurers under the Affordable Care Act (ACA) without additional cost to the patient.
The case arises from religious objections to covering pre-exposure prophylaxis (PrEP), a drug effective against HIV, by plaintiffs including four individuals and two small businesses, notably Braidwood Management. The plaintiffs argue that the task force’s structure violates the U.S. Constitution’s appointments clause, which mandates that “principal officers” be appointed by the President and confirmed by the Senate. The task force’s recommendations have included services such as contraception and cancer screenings, but have stirred controversy due to the inclusion of PrEP, which plaintiffs argue promotes behaviors contrary to their religious beliefs.
Previously, U.S. District Judge Reed O’Connor sided with the plaintiffs, invalidating the preventive-care coverage mandates from the task force imposed since the ACA’s 2010 enactment. The Fifth Circuit upheld that the task force’s structure violates the appointments clause but limited the impact, ruling that the coverage requirements apply only to the plaintiffs, leaving other mandates intact.
The Biden administration has appealed to the Supreme Court, defending the task force’s structure as falling under HHS oversight, with members considered “inferior officers,” hence not requiring Presidential appointment or Senate confirmation. The administration argues that HHS retains supervisory control, rendering the task force’s process constitutional.
This case poses substantial implications for the ACA and public health. For instance, the American Hospital Association expressed concern that altering current preventive services coverage would lead patients to forgo necessary care due to cost. Public health groups emphasize that restricting access to PrEP could hamper efforts to eradicate HIV in the U.S., and contribute to regressing in public health achievements.
Conversely, the plaintiffs, supported by entities like the Goldwater Institute, argue that the potential fallout is overstated and recommend that any constitutional issues be resolved legislatively rather than judicially. The Supreme Court’s decision, expected by mid-2025, will likely have significant ramifications not only for preventive health coverage but also for interpretations of the separation of powers within the U.S. government.