{"id":34694,"date":"2025-06-27T13:57:44","date_gmt":"2025-06-27T17:57:44","guid":{"rendered":"https:\/\/advisory.avalerehealth.com\/?p=34694"},"modified":"2025-06-27T14:06:58","modified_gmt":"2025-06-27T18:06:58","slug":"supreme-court-upholds-zero-cost-preventive-care-rule","status":"publish","type":"post","link":"https:\/\/advisory.avalerehealth.com\/insights\/supreme-court-upholds-zero-cost-preventive-care-rule","title":{"rendered":"Supreme Court Upholds Zero-Cost Preventive-Care Rule"},"content":{"rendered":"

On June 26, the US Supreme Court issued a <\/span>6-3 ruling<\/span><\/a> in <\/span>Kennedy v. Braidwood Management <\/span><\/i>that reversed a Fifth Circuit ruling and held that members of the U.S. Preventive Services Task Force (USPSTF) are \u201cinferior officers\u201d who may be appointed by\u2014and remain removable by\u2014the Secretary of the Department of Health and Human Services (HHS). In the majority opinion, Justice Brett Kavanaugh emphasized that the Secretary holds the power to review and countermand any USPSTF recommendations, placing the task force squarely under executive supervision, satisfying the Appointments Clause. <\/span>\u00a0<\/span><\/p>\n

In the ruling, the Supreme Court states \u201cThe Executive Branch under both President Trump and President Biden has argued that the Preventive Services Task Force members are inferior officers and therefore may be appointed by the Secretary of HHS. We agree. The Task Force members are removable at will by the Secretary of HHS, and their recommendations are reviewable by the Secretary before they take effect.\u201d<\/span>\u00a0<\/span><\/p>\n

Background on USPSTF<\/span><\/b>\u00a0<\/span><\/p>\n

USPSTF is an independent panel of 16 experts appointed by the HHS Secretary that voluntarily provide recommendations on preventive services for adults and children provided in or referred from the primary care setting. According to the <\/span>USPSTF procedure manual<\/span><\/a>, the Task Force evaluates specific interventions and issues recommendation with a letter grade (A, B, C, D, or Insufficient [I] statement) based on the strength of existing evidence and the net benefits of a preventive service. Under the Affordable Care Act (ACA), services that receive a USPSTF Grade A or Grade B must be covered by Medicare and third-party insurance carriers without member cost sharing.<\/span>\u00a0<\/span><\/p>\n

Legal Challenges to Preventive Services Coverage Mandate<\/span><\/b>\u00a0<\/span><\/p>\n

In September 2022, the US District Court for the Northern District of Texas issued a\u202f<\/span>ruling\u202f<\/span><\/a>in\u202f<\/span>Braidwood Management Inc. vs.\u202fBecerra, <\/span><\/i>a case<\/span> which challenged the legality of the ACA\u2019s <\/span>preventive services<\/span><\/a> coverage mandate under the US Constitution and the Religious Freedom Restoration Act. The court ruled that health plans are not required to cover services recommended by the USPSTF because its panel members are not properly appointed under the Constitution\u2019s Appointments Clause. Following the decision, the Biden administration appealed the court\u2019s ruling to the US Court of Appeals for the Fifth Circuit,<\/span>\u00a0<\/span><\/p>\n

In June 2024, the court of appeals issued a\u202f<\/span>decision<\/span><\/a>\u202freversing the lower court\u2019s decision to vacate all agency actions to enforce preventive care coverage mandates. However, the appellate ruling agreed with the lower court\u2019s ruling that the USPSTF panel had not been validly appointed under the Appointments Clause.<\/span> \u00a0<\/span><\/p>\n

The case was appealed to the Supreme Court and on April 21, 2025, justices heard oral arguments in <\/span>Kennedy vs. Braidwood Management Inc<\/span><\/i><\/a>.\u00a0<\/span>\u00a0<\/span><\/p>\n

Why the Ruling Matters<\/span><\/b>\u00a0<\/span><\/p>\n

The ruling preserves the ACA requirement that commercial and employer health plans cover <\/span>USPSTF Grade A or Grade B recommendations <\/span>without cost-sharing. The decision averts an immediate disruption to no-cost coverage for over fifty types of screenings, prevention medication, and counseling recommendations. This ruling maintains frictionless access to preventive screening without introducing additional cost sharing for patients. Importantly, the Supreme Court\u2019s reasoning also reinforces the legal foundation for other HHS-appointed expert bodies like the Advisory Committee on Immunization Practices, which similarly issue coverage-influencing recommendations without Senate confirmation\u2014an increasingly important precedent as public attention grows around new member appointments, transparency, and the scope of advisory authority.<\/span> \u00a0<\/span><\/p>\n

Next Steps<\/span><\/b>\u00a0<\/span><\/p>\n

Avalere Health\u2019s cross functional team is uniquely capable of supporting stakeholders navigating the evolving landscape of USPSTF recommendations and <\/span>submission processes<\/span><\/a>. Understanding the access landscape for screening requires a partner with strategic foresight and deep expertise in evidence, policy, and quality frameworks. Leveraging expertise in evidence generation and planning, market strategy, and policy shaping, Avalere Health can provide strategic recommendations that meet individual client needs. To learn more about how Avalere Health can assist you <\/span>connect with us.<\/span><\/a>\u00a0<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

On June 26, the US Supreme Court issued a 6-3 ruling in Kennedy v. Braidwood Management that reversed a Fifth Circuit ruling and held that members of the U.S. Preventive Services Task Force (USPSTF) are \u201cinferior officers\u201d who may be appointed by\u2014and remain removable by\u2014the Secretary of the Department of Health and Human Services (HHS).…<\/p>\n","protected":false},"author":17,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[3],"tags":[],"content-categories":[259],"class_list":["post-34694","post","type-post","status-publish","format-standard","hentry","category-insights","content-categories-policy","entry","no-media"],"acf":[],"yoast_head":"\nSupreme Court Upholds Zero-Cost Preventive-Care Rule | Avalere Health Advisory<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/advisory.avalerehealth.com\/insights\/supreme-court-upholds-zero-cost-preventive-care-rule\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Supreme Court Upholds Zero-Cost Preventive-Care Rule | Avalere Health Advisory\" \/>\n<meta property=\"og:description\" content=\"On June 26, the US Supreme Court issued a 6-3 ruling in Kennedy v. 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