Kennedy v. Braidwood: The Supreme Court Upheld ACA Preventive Services but That’s Not the End of the Story
Laurie Sobel, Lindsey Dawson, and Alina Salganicoff
Published:
On June 27, 2025, the U.S. Supreme Court issued the most recent opinion in a long history of challenges to different elements of the Affordable Care Act (ACA). In this case, Kennedy v. Braidwood Management, the Court ruled (6-3) that the ACA requirement that most private insurers and Medicaid expansion programs cover preventive services recommended by the United States Preventive Services Preventive Task Force (USPSTF) with no cost-sharing is constitutional. This means that these services continue to remain available without cost-sharing to most individuals with private coverage. About 100 million privately insured people get preventive services each year without cost-sharing under the ACA’s requirement.
Box 1: Preventive Services Coverage Requirements under the ACA
Section 2713 of the ACA requires most private health insurance plans and Medicaid expansion programs to cover recommended preventive services without any patient cost-sharing. Preventive services include a range of services such as screening tests, immunizations, behavioral counseling, and medications that can prevent the development or worsening of diseases and health conditions.
Preventive services that must be covered are:
- those receiving an A or B grade by the U.S. Preventive Services Task Force (USPSTF),
- vaccines recommended by the Advisory Committee on Immunization Practices (ACIP),
- Health Resources and Services Administration (HRSA) recommendations based on the Women’s Preventive Services Initiative and the Bright Futures for Children program.
All of these entities review new recommendations and conduct periodic updates of existing recommendations.
In this case, the only question before the Court was whether the process for appointing USPSTF members by the Secretary of Health and Human Services violated the Constitution’s Appointments Clause in Article II, which provides that “officers of the United States” may only be appointed by the president, subject to the advice and consent of the Senate. The respondents (Braidwood et al.) contended it did while the petitioners (Health and Human Services Agency) claimed the opposite. The court writes, “that question turns on whether the Task Force members are principal officers or inferior officers.” Inferior officer the Court writes, “are those ‘whose work is directed and supervised at some level by others who were appointed by Presidential nomination with the advice and consent of the Senate.’”
In its ruling, the Supreme Court held that the structure of the USPSTF does not violate the Constitution’s appointment clause. The Court agreed with the federal government, finding that the HHS Secretary has the power to remove USPSTF members at will and to review the recommendations they issue. The court writes “The Secretary of HHS has the power to appoint (and has appointed) the Task Force members… and no statute restricts removal of Task Force members. Therefore, ‘there can be no doubt’ that the Secretary may remove Task Force members at will.”
While the Court’s decision upholds the current ACA USPSTF coverage requirements, it will likely not be the final word on the preventive services that the ACA requires plans to cover free of cost-sharing. The Trump administration could change the membership of the USPSTF in ways that may significantly alter the recommendations it issues or ask the USPSTF re-consider earlier recommendations that it disagrees with. If members were removed and no new members appointed, this could delay review of new services or updates to existing services which would have implications for access under the ACA provision and for providers who look to USPSTF recommendations as clinical guidance.
In their briefs, the Trump administration also raised that they have the authority to indefinitely delay the implementation of recommendations issued by USPSTF and that the Secretary may have additional authority to supervise and veto Task Force recommendations, something that no prior administrations has ever done. In their brief, the administration stated, “In addition to removing Task Force members at will, the Secretary may supervise and review their recommendations directly.”
Demonstrating this authority earlier this month, albeit for a separate but somewhat similar body, Secretary Kennedy fired all 17 ACIP members and appointed eight new committee members. In a very short time, the newly formed committee has begun to not only review the recommendations for new and updated immunizations, it has said it will also re-evaluate the long-standing childhood vaccine schedule and reconsider its approval of vaccines that have been recommended for decades, and in the case of a type of flu vaccine, already has done so.
Box 2: The Challenge to USPTSF Recommendation to Cover PrEP for HIV Prevention
One service that could have been impacted by the court’s decision is pre-exposure prophylaxis (PrEP), a drug recommended by the USPSTF that reduces the risk of acquiring HIV by approximately 99% through sex and 74% through injection drug. While the decision preserves coverage of a range of services, the PrEP coverage requirement was a key element of the Braidwood dispute. In the original case, filed in 2022, the plaintiffs objected to the coverage requirement stating that covering PrEP “imposes a substantial burden on the religious freedom of those who oppose homosexual behavior on religious grounds” claiming further that PrEP drugs “facilitate and encourage homosexual behavior, prostitution, sexual promiscuity, and intravenous drug use.”
The Court ruling means that those with private insurance can continue to have access to PrEP and associated services (provider visits and necessary labs) without cost-sharing. Given that over 80% of PrEP users are covered by commercial insurance, the decision impacts the majority of PrEP users. Actual and perceived costs have historically been one of many barriers to PrEP use. As a very costly drug, with branded versions costing tens of thousands of dollars annually, along with sometimes expensive ancillary services, these cost-sharing protections stand to have a substantial protective impact on consumers.
Currently just 36% of those who might benefit from PrEP are prescribed it and racial/ethnic and gender disparities persist.
In this case, the Supreme Court narrowly considered whether the structure of the USPSTF violates the Appointments Clause, but did not review the litigants’ other claims about ACIP or HRSA. The federal district court will now resume briefing on the consideration of the plaintiffs’ claim that the Secretary of Health and Human Services’ ratification of HRSA and ACIP recommendations violates the Administrative Procedure Act. In addition, the original plaintiffs prevailed in the lower court on their claims that the requirement to cover PrEP violated their religious rights. While the Supreme Court did not review the religious claims brought by the original plaintiffs in this case, the Court has ruled in other cases brought on religious grounds challenging the ACA’s contraceptive coverage requirement, a recommendation from HRSA’s preventive services for women. In those cases, the Supreme Court ruled that exceptions are needed to accommodate employers with religious objections to contraception. Given the ongoing litigation in the lower courts and the Trump administration’s recent actions on vaccine recommendations, the Braidwood case is not likely to be the last word on the ACA preventive services coverage requirements.