Kennedy v. Braidwood Management, Inc.
The Supreme Court ruled 6–3 that the Secretary of Health and Human Services can lawfully appoint members of the Preventive Services Task Force — the federal body whose recommendations determine which health services insurance plans must cover for free — upholding the ACA's no-cost preventive care requirements.
The decision preserves free coverage of more than 40 preventive services, including cancer screenings and diabetes tests, by confirming that the Task Force's appointment structure does not violate the Constitution's rules for selecting federal officers.
“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. So Task Force members are supervised and directed by the Secretary, who in turn answers to the President, preserving the chain of command in Article II.”
The majority's core statement of why Task Force members are inferior officers whose appointments are constitutionally valid.
How it got here: A federal district court ruled Task Force members were unconstitutionally appointed; the Fifth Circuit affirmed; the federal government asked the Supreme Court to step in and the Court agreed to hear the case.
The Case in Depth
What happened
The U.S. Preventive Services Task Force is a body of 16 volunteer medical experts within the Department of Health and Human Services. Since 2010, the Affordable Care Act has required most health insurers to cover services the Task Force rates "A" or "B" at no cost to patients — covering over 40 services including cancer screenings and preventive medications. Braidwood Management, a Texas company with about 70 employees, objected to covering certain services and sued, arguing that the Task Force members were unconstitutionally appointed.
The question before the Court
Can the Secretary of Health and Human Services appoint the members of the Preventive Services Task Force, or must those members go through presidential nomination and Senate confirmation?
The Court's answer
Yes — the Secretary of HHS can lawfully appoint Task Force members. The Court held that Task Force members are "inferior officers" rather than "principal officers" under the Constitution. Because their work is supervised and directed by the Secretary — who can remove them at will and can review and block their recommendations during the required one-year window before recommendations become binding — they do not wield independent, unreviewable authority. Inferior officers may be appointed by a department head rather than requiring Senate confirmation.
The Court also found that Congress did vest appointment authority in the Secretary through two laws read together: a 1999 statute authorizing the AHRQ Director to "convene" the Task Force (which the Court read to include selecting its members), and a 1966 Reorganization Plan ratified by Congress in 1984 that transferred all Public Health Service officer functions — including the AHRQ Director's — to the Secretary. Since June 2023, the Secretary has personally appointed all Task Force members, satisfying the Appointments Clause.
Curious how the Court got there? See the step-by-step legal reasoning →
Why it matters
Tens of millions of Americans rely on the Affordable Care Act's guarantee of free preventive care — cancer screenings, cholesterol medications, diabetes tests, and more. A ruling the other way would have invalidated or disrupted coverage requirements for all Task Force recommendations issued since 2010, potentially requiring insurers to start charging copays for those services.
What changes now
The case returns to the Fifth Circuit for further proceedings consistent with the Supreme Court's ruling. The ACA's no-cost preventive services coverage requirements remain in force. The Secretary of HHS continues to appoint Task Force members. A separate injunction protecting Braidwood from covering certain HIV-prevention drugs on religious-liberty grounds was not appealed and is unaffected by this decision. Other challenges to specific coverage mandates may continue in lower courts.
What this does not decide
The ruling does not address whether the ACA's preventive services mandates are legally valid on other grounds, such as the separate religious-liberty claim. It also does not decide the validity of Task Force recommendations issued before June 2023, when members were appointed only by the AHRQ Director rather than the Secretary — those remedial questions remain open on remand.
Concurrences and dissents
How the Justices voted
Majority (6). Justice Kavanaugh (author), joined by Justice Roberts, Justice Sotomayor, Justice Kagan, Justice Barrett, and Justice Jackson.
Dissent (3). Justice Thomas (author), joined by Justice Alito and Justice Gorsuch.
Dissent — Justice Thomas
Justice Thomas would have sent the case back to the Fifth Circuit without ruling on the key statutory question — whether Congress ever gave the Secretary authority to appoint Task Force members — since no lower court had addressed it. On the merits, he argued that the word 'convene' in the 1999 statute does not mean 'appoint,' that Reorganization Plan No. 3 does not transfer later-created appointment powers, and that Congress designed the Task Force to be an independent body answering directly to the President, not subordinate to the Secretary. He would have affirmed the Fifth Circuit on different grounds. Read the full dissent →
How the Court got there
The legal reasoning, step by step
- The Appointments Clause in Article II divides all federal officers into two categories. 'Principal officers' — like Cabinet secretaries — must be nominated by the President and confirmed by the Senate. 'Inferior officers' are those whose work is directed and supervised by a principal officer; Congress may allow a department head to appoint them directly without Senate involvement.
- The Court applied the governing test from Edmond v. United States (1997): an officer is 'inferior' if his work is 'directed and supervised at some level' by someone who was Senate-confirmed. The key signals are whether the superior can remove the officer at will and whether the superior can review and override the officer's decisions.
- The Secretary's power to remove Task Force members at will — which flows automatically from the Secretary's appointment power, since no statute restricts removal — gives the Secretary a powerful tool of control. An officer's presumed desire to avoid removal creates what the Court calls 'here-and-now subservience,' meaning the officer must heed the Secretary's preferences.
- Beyond removal, the Secretary has statutory authority to directly review and block Task Force recommendations before they bind insurers. During the legally required minimum one-year gap between a recommendation and its effective date, the Secretary can use his general supervisory authority over the Public Health Service (under 42 U.S.C. § 202 and Reorganization Plan No. 3) and his rulemaking power under the ACA to declare a recommendation not 'in effect.' Task Force members therefore cannot make a truly final decision if the Secretary objects.
- The Court concluded this result flows directly from three prior cases: Edmond (Coast Guard judges removable at will and subject to appellate review = inferior), Free Enterprise Fund (accounting board members removable at will = inferior despite significant independent powers), and Arthrex (patent judges reviewable but not removable at will = still inferior). Task Force members face both forms of control, so they are clearly inferior officers.
- On the appointment authority question, the Court read the 1999 statute's grant to the AHRQ Director to 'convene' the Task Force as implicitly including the power to appoint its members — since no other provision specifies a different appointer — and held that Reorganization Plan No. 3 of 1966 (ratified by Congress in 1984) transferred all of the Director's functions, including that appointment power, to the Secretary on a continuing basis as new authorities were conferred after 1966.
Doctrinal impact
Cases affected by this decision
Reaffirms Edmond v. United States (520 U. S. 651)
Reaffirmed as the controlling test for distinguishing inferior from principal officers: supervision and direction by a Senate-confirmed superior.
Reaffirms Free Enterprise Fund v. Public Company Accounting Oversight Bd. (561 U. S. 477)
Reaffirmed that officers removable at will by a superior are inferior officers even when they wield significant independent authority.
Reaffirms United States v. Arthrex, Inc. (594 U. S. 1)
Reaffirmed that review authority by a superior, even without at-will removal, can render officers inferior under the Appointments Clause.
Reaffirms Collins v. Yellen (594 U. S. 220)
Reaffirmed that labeling an agency or officer 'independent' in a statute does not, by itself, create for-cause removal protection.