## Facts

- The Affordable Care Act requires most private insurers and group health plans to cover, without cost sharing, preventive services receiving “A” or “B” ratings from the U.S. Preventive Services Task Force (USPSTF).
- USPSTF is a 16-member volunteer body that issues evidence-based recommendations on preventive care; its members are appointed by the Secretary of Health and Human Services (HHS) to staggered four-year terms.
- Respondents, including a Christian-owned employer with a self-insured plan, objected to being required to cover certain preventive services (including HIV pre-exposure prophylaxis (PrEP)) on constitutional and religious grounds.
- Respondents argued USPSTF recommendations became legally binding through the ACA and that USPSTF members therefore must be appointed as principal officers by the President with Senate confirmation.
- The district court held the USPSTF structure violated the Appointments Clause and granted broad relief limiting enforcement of USPSTF-based coverage requirements; it also sustained certain claims under the Religious Freedom Restoration Act (RFRA).
- The court of appeals agreed an Appointments Clause violation existed but limited relief to the plaintiffs and remanded for additional issues.
- The Supreme Court granted review limited to the Appointments Clause and related structural questions concerning USPSTF; RFRA issues were left for further proceedings on remand.

## Issues

1. Whether USPSTF members are principal officers whose appointment requires presidential nomination and Senate confirmation, making appointment by the HHS Secretary unconstitutional under the Appointments Clause.
2. If the USPSTF’s structure is unconstitutional, whether statutory language describing USPSTF recommendations as “independent” is severable to cure the defect.

## Decision

- The Court reversed and remanded in a 6–3 decision.
- The Court held USPSTF members are inferior officers whose appointment by the HHS Secretary complies with the Appointments Clause.
- Because the Court found no constitutional defect, it did not reach severability of the “independence” language.
- The Court’s ruling left remaining non-structural challenges, including RFRA claims, for further proceedings.

## Legal Principles

- Officers are “inferior” for Appointments Clause purposes when their work is directed and supervised at some level by Senate-confirmed officers, including through meaningful removal authority and supervision over implementation.
- Fixed terms, delegated statutory duties, and legal consequences flowing from an official’s actions may establish officer status, but do not alone make the official a principal officer.
- Statutory references to “independence” may be construed as protecting professional judgment rather than creating insulation that defeats executive supervision, particularly when qualified by language such as “to the extent practicable.”
- When no Appointments Clause violation is found, a court need not decide severability of provisions asserted to create unconstitutional insulation.

## Conclusion

The Court upheld the constitutionality of using USPSTF “A” and “B” recommendations to define mandatory no-cost preventive services under the ACA, concluding that USPSTF members are inferior officers validly appointed by the HHS Secretary and sufficiently supervised within the executive branch.


Kennedy v. Braidwood Mgmt., Inc., 606 U.S. 748 (2025)