Supreme Court Case Threatens Preventive Care Mandate
Author(s): Scott Douglas Jacobsen
Publication (Outlet/Website): The Good Men Project
Publication Date (yyyy/mm/dd): 2025/05/14
Professor Stacey B. Lee of Johns Hopkins discusses a pivotal Supreme Court case challenging the U.S. Preventive Services Task Force’s authority under the Affordable Care Act. Plaintiffs argue the Task Force violates the Appointments Clause, potentially limiting HHS’s ability to mandate no-cost preventive care. Lee outlines the legal, policy, and public health stakes, warning of impacts on 50 million Americans and broader threats to agency authority. She emphasizes the vital role of medical experts and highlights the contrast between U.S. religious influence on healthcare policy and evidence-based approaches seen in other democracies.
Scott Douglas Jacobsen: Today, we are here with Stacey B. Lee, JD. She is a Professor at Johns Hopkins University, with appointments at both the Carey Business School and the Bloomberg School of Public Health. Professor Lee combines academic excellence with over a decade of legal and regulatory experience. Her forthcoming book, Transforming Health Care Through Negotiation (Routledge, 2025), introduces tools for improving care delivery and health outcomes. She is also a Fulbright Specialist, a court-appointed mediator, and a TEDx speaker. Professor Lee is a frequent contributor to outlets such as CNN, NPR, and The Washington Post. Through her teaching and leadership, she is reshaping healthcare negotiations across both clinical and administrative domains. Thank you very much for joining me today. What legal argument has been presented to the Supreme Court regarding the U.S. Preventive Services Task Force?
Professor Stacey B. Lee: What’s interesting about this case is that one of the most widely supported provisions of the Affordable Care Act is the mandate for no-cost preventive services. The plaintiffs in this case argue that the U.S. Preventive Services Task Force (USPSTF), which identifies which services must be covered without cost-sharing, violates the Appointments Clause of the U.S. Constitution. The USPSTF is composed of volunteer experts—mostly physicians—who are appointed by the director of the Agency for Healthcare Research and Quality (AHRQ), not by the President or confirmed by the Senate. Under the ACA, insurers must follow their recommendations for certain preventive services to be covered without out-of-pocket costs. The plaintiffs argue that these recommendations have the force of law but are made by individuals not constitutionally authorized to wield such authority. They claim this delegation violates the Appointments Clause because the members are neither principal nor inferior officers appointed correctly in Article II of the Constitution. Therefore, the plaintiffs are asking the Supreme Court to invalidate the mandate on this constitutional basis.
Jacobsen: How does this test the authority of the Department of Health and Human Services (HHS)?
Lee: If the Court sides with the plaintiffs, it would significantly constrain HHS’s ability to enforce the preventive care mandate under the ACA. HHS relies on the USPSTF to determine which services must be covered without cost-sharing. If the Court ruled that the USPSTF’s authority was unconstitutional, HHS would no longer have a valid legal mechanism to enforce these mandates through that task force. Essentially, it would put HHS in a regulatory bind. They would either need Congress to amend the ACA to provide a new mechanism for determining required preventive services or restructure the task force’s appointment process to comply with constitutional requirements. The ripple effect could extend to other bodies within HHS that are similarly structured, depending on the scope of the Court’s reasoning.
Chief Justice Roberts perhaps gave a nod to something during oral arguments that might offer a potential way out. The U.S. Preventive Services Task Force is an independent body, and it was specifically designed to be independent so it could remain nonpartisan—able to make informed decisions about what constitutes preventive care without political interference. However, HHS, in theory, has no authority to direct or influence those decisions.
If the Supreme Court were to strike down the part that defines the U.S. Preventive Services Task Force as an independent agency—and instead place it under the authority of HHS—that could be a functional solution. HHS could then, theoretically, accept or reject the Task Force’s recommendations. Whether or not that’s a legal fiction, it would address the constitutional concern being raised. So that’s one path forward.
Absent that outcome, HHS could issue new regulations to re-establish the preventive services mandate, but given the current political and regulatory landscape, I’m not overly confident that would happen quickly, or at all. Even if it did happen, there would still be a gap in coverage. During that gap, insurers could choose whether to continue covering those services voluntarily. Some may say, “We’re going to keep covering this because it’s the right thing to do,” while others might say, “We’re not required to anymore, so we’re not going to.” Until new regulations are implemented, nothing obligates them to continue coverage. This could affect around 50 million Americans.
So, the two options are as follows: (1) HHS issues new regulations, which is uncertain and slow; or (2) the Court severs the independence of the Task Force and effectively brings it under the control of HHS. In theory, that would be a temporary fix—until the Fifth Circuit comes up with another legal attack on the Affordable Care Act.
Jacobsen: What precedent could this ruling set for administrative law?
Lee: Oh, this could upend everything. It could continue the trajectory we’re beginning to see where the Supreme Court is increasingly open to clawing back agency deference, particularly through the weakening or overturning of Chevron deference. That means it could significantly reduce the powers of federal agencies and challenge the legitimacy of the administrative state more broadly. Your question on administrative law is a serious one. This could call into question the role and authority of not only the U.S. Preventive Services Task Force, but also dozens of similar advisory bodies embedded across the federal government. It would make many agencies vulnerable to similar constitutional challenges.
Jacobsen: What does this mean for public health infrastructure?
Lee: I wanted to keep the questions light today, so let’s keep the answer light. Just kidding. What’s at stake is real and personal. Imagine a dad taking his daughter to get the HPV vaccine, an African American patient trying to manage his diabetes, or a veteran staying on top of preventive care. Suddenly, those visits might come with unexpected bills. Preventive care has long enjoyed bipartisan support. We’ve spent years encouraging Americans to seek it out, and if the Court sides with the plaintiffs, we will be taking a massive step backward. By now, we’ve spent years getting Americans used to the idea that preventive services—like mammograms, colonoscopies, diabetes screenings, and statins—are routine and vital. We’ve been gradually shifting the public mindset toward early intervention, so bigger health problems do not emerge later. But if this case results in rolling back the mandate, people will suddenly find surprise medical bills in their mailboxes for those very services. That would be a real step backward in our effort to improve the health of Americans.
Jacobsen: How might this case impact future policy challenges regarding the scope of federal healthcare programs?
Lee: It should make all administrative agencies nervous. A ruling like this would signal that the Supreme Court is prepared to say: unless Congress gives you specific authority to do something, you cannot do it. That undermines the jurisdiction of agencies that were intentionally structured to be independent and nonpartisan, like expert health committees. This case could call into question the legitimacy of advisory bodies that were created to insulate evidence-based decisions from political interference. And I won’t go further down that road, but yes—it would be bad. B-A-D, all caps, exclamation point, as a tweet. Bad. All bad. Sad.
Jacobsen: What is the role of medical and public health experts in defending the preventive care mandate?
Lee: It is absolutely critical. In our current political climate, these types of expert bodies—where we rely on medical professionals—are more crucial than ever. As we begin to see a cultural and political pushback against things like vaccines and preventive care, it becomes vital that we have grounded, evidence-based institutions guiding healthcare policy. These professionals help keep the system anchored in science and public health, rather than political trends.
Jacobsen: If the decision goes against the ACA, what legal or legislative strategies may preserve access to preventive care on a national scale?
Lee: The Supreme Court could strike only the part of the statute that makes the advisory body “independent”—essentially reclassifying it under HHS. That would allow HHS to take ownership of the recommendations and issue guidance accordingly. Alternatively, Congress could enact legislation explicitly establishing the authority for preventive services. But to be honest, the Braidwood plaintiffs raised two challenges. The Supreme Court is only hearing one of them: the constitutionality of how the preventive services list is created. The other challenge—one the Court chose not to listen—argues that certain preventive services violate the religious beliefs of the plaintiffs and therefore should not be mandated.
If Congress has to develop the list of preventive services from scratch, it opens the door to competing political interests. Arguments based on religious or moral objections might find a more favourable reception. The entire reason we created an independent advisory body of doctors and scientists, rather than politicians, was to base coverage decisions on evidence and not on ideology or belief systems. That independence is what’s now at risk.
Jacobsen: So how does this situation—politically, legislatively, and legally—compare to other advanced industrial economies with cosmopolitan, pluralistic values like much of Western Europe and Canada? How does this compare to contexts like those you’ve studied in your professional assessment?
Lee: One of the unique things about the United States is that our cultural and constitutional values play a significant role in shaping medical decisions. While there is often a clear medical or scientific answer to a question, our First Amendment protections mean that religious beliefs can carry equal—or in some cases, more—weight than scientifically supported recommendations. I do not think you see that same dynamic in most other countries.
For example, there are medical answers to questions such as when life begins or ends, and yet in the U.S., those answers are regularly contested in legislatures and in the courts. What makes us particularly unique is that religious belief has a constitutionally protected status, even when it may contradict scientific consensus. In many other countries, you do not see that same tension, and their laws tend to reflect a more consistently evidence-based approach to medical policy and decision-making.
Jacobsen: Thank you for the opportunity and your time, Professor Lee.
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