Supreme Court Weighs ACA Preventive Services Coverage Amid Appointment Clause Challenge
The Affordable Care Act's (ACA) preventive services coverage requirement, which mandates payer coverage for services recommended with an A or B rating by the U.S. Preventive Services Task Force, faces a significant constitutional challenge in the Supreme Court case Kennedy v. Braidwood.
The core issue revolves around whether the Task Force’s structure violates the Constitution's Appointments Clause, as challengers argue that its members should require Senate confirmation due to their influence on healthcare coverage for over 150 million Americans.
The case questions the statutory independence of the Task Force and the authority of the Secretary of Health and Human Services (HHS) to appoint its members, focusing on the interpretation of the words “independent” and “convene.” During oral arguments, Justices Amy Coney Barrett and Brett Kavanaugh expressed a readiness to uphold the Task Force's role, viewing its independence as ensuring expert recommendations free from conflicts of interest rather than complete political isolation.
However, the justices raised questions about whether convening the Task Force equates to appointing its members, with conservative justices challenging the scope of the HHS Secretary’s appointing power. The Court requested supplemental briefs to explore precedent cases dating back to the 19th century, highlighting the gravity and complexity of the appointment authority issue. The decision, anticipated by late June, could uphold the Task Force's mandate if at least two justices among Roberts, Kavanaugh, or Barrett agree on the Secretary's appointing authority, potentially affirming recommendations made since 2023 but raising doubts about earlier guidance.
Conversely, invalidating the Task Force's role would nullify the preventive coverage mandate, requiring Congressional action to restore mandatory service coverage through Senate confirmations or legislative fixes. A ruling against the Task Force may lead to a gradual erosion of preventive service coverage via increased utilization management, prior authorizations, cost-sharing, and narrowed access, creating inconsistency across markets and complicating provider and patient understanding of benefits.
Such outcomes could hinder investment in preventive health innovations and reverse progress made over 15 years toward improved population health and cost control. The case holds substantial implications for insurance compliance, regulatory oversight, provider and payer operations, and market stability surrounding preventive healthcare services under the ACA.