March 12, 2025

The U.S. Supreme Court has scheduled oral arguments for April 21 in Braidwood Management v. HHS, a case challenging the constitutionality of the Affordable Care Act’s (ACA) preventive care mandate. The case, which has been closely followed by employers and health plan sponsors, focuses on whether the U.S. Preventive Services Task Force (USPSTF) was lawfully granted authority to determine mandatory preventive services.

Under the ACA, non-grandfathered health plans must cover a defined set of preventive services without cost-sharing. These services are determined by three expert bodies: the USPSTF, Advisory Committee on Immunization Practices (ACIP), and the Health Resources and Services Administration (HRSA). The Braidwood plaintiffs argue that the ACA’s reliance on USPSTF recommendations is unconstitutional because its members were not appointed by the President and confirmed by the Senate. The plaintiffs also assert that the mandate violates the Religious Freedom Restoration Act (RFRA).

In June 2024, the Fifth Circuit Court of Appeals ruled that the USPSTF’s structure is unconstitutional and violates the Appointments Clause, rendering its recommendations unenforceable. However, the court limited its ruling to the specific plaintiffs rather than issuing broader relief. In September 2024, the Biden administration petitioned the Supreme Court to review the decision, and the Court granted certiorari in January 2025.

Despite the change in administration, the Trump administration submitted a brief to SCOTUS indicating that they will be defending the ACA’s preventive services mandate and authority of USPSTF, adopting the same core arguments advanced by the Biden administration. In its brief to the Supreme Court, the administration argued that:

• USPSTF members are “inferior officers” under the Constitution, meaning they do not require Senate confirmation.
• The Secretary of HHS retains sufficient authority over USPSTF recommendations, including the ability to delay implementation of new mandates, ensuring proper oversight.
• Even if the Court finds a constitutional defect, it should sever the problematic provision rather than invalidating the entire preventive care mandate.

SCOTUS’ decision in Braidwood carries significant implications for preventive care requirements under the ACA. While employer plan sponsors have long been committed to investing in preventive services and other initiatives to help ensure that employees and their families are getting early, lower cost medical care to avoid higher cost treatments and worse health outcomes, a broadening of the Appellate Court’s finding that the USPSTF was unconstitutionally appointed may permit employers to take a fresh look at the items and services they 100% cover (no cost-sharing) to ensure they are appropriately investing in the needs of their population. The Business Group will provide further updates following the April 21 hearing and eventual SCOTUS decision.

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Resource Affordable Care Act (ACA)