The Affordable Care Act, USPSTF, and the Braidwood Case: A Legal Shift?
The Affordable Care Act (ACA) mandates that most commercial health insurance plans cover preventive services recommended by the U.S. Preventive Services Task Force (USPSTF) without cost-sharing. While the connection to Medicare is less direct, Medicare can choose to create National Coverage Determinations (NCDs) that align with USPSTF-endorsed services on a case-by-case basis.
A major legal challenge, Braidwood v. Becerra—now likely renamed Braidwood v. Kennedy—questions USPSTF's authority to set these benefit requirements. The plaintiffs have seen some legal victories, raising the possibility that USPSTF’s role in shaping mandatory preventive coverage could be canceled.
Notably, a newly filed brief reveals an unexpected legal stance: the Trump Administration will support USPSTF’s authority.
That means Trump’s legal team will argue to overturn lower court rulings that challenged USPSTF’s power. However, winning this argument at the Supreme Court (SCOTUS) this spring is key. Merely defending USPSTF's authority isn’t enough—the administration must prevail at SCOTUS to maintain the current structure of preventive care coverage under the ACA, and "Braidwell" have been winning so far.
Here's an upload of the 62-page brief:
https://www.scribd.com/document/830575445/20250218171629934-24-316tsUnitedStates-1
Here's my Google Drive open access copy:
https://drive.google.com/file/d/1Vfor_nPLNKkfqE6nq3M2gXtXOdvgqeuR/view?usp=sharing
See the website of the Center for Value-Based Insurance Design:
https://vbidcenter.org/initiatives/braidwood-becerra/
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AI CORNER
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Here is an AI review of the DOJ brief, why it thinks lower courts have been getting this case wrong.
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From the DOJ's brief in the 62-page Braidwood v. Kennedy case, here are the key reasons why the DOJ is hopeful of winning at SCOTUS and upholding the USPSTF’s authority:
1. Strong Precedent on Inferior vs. Principal Officers
- The DOJ argues that USPSTF members are “inferior officers” rather than principal officers, meaning their appointment process is constitutional.
- SCOTUS has previously ruled in Edmond v. United States (1997) and Arthrex (2021) that officers are “inferior” when they are supervised by a higher-ranking official, which applies here since the HHS Secretary can remove Task Force members at will and influence their work.
2. The HHS Secretary Has Final Authority Over USPSTF Recommendations
- The DOJ highlights that the HHS Secretary can override or delay the implementation of Task Force recommendations, meaning they are not truly independent decision-makers with final authority.
- In past SCOTUS cases, if a superior officer retains oversight power, the Appointments Clause challenge usually fails.
3. Court's Misinterpretation of the “Independence” Clause
- The Fifth Circuit interpreted the statutory language requiring the USPSTF to be “independent” as completely insulating them from HHS oversight, but the DOJ argues this is a misreading.
- The phrase “to the extent practicable” in the law means there is room for executive oversight, which the government argues is sufficient to meet constitutional requirements.
4. Severability as a Safety Net
- Even if SCOTUS agrees that USPSTF’s structure is flawed, the DOJ argues that the problem can be fixed by severing a single provision (42 U.S.C. § 299b-4(a)(6)), just as SCOTUS did in Arthrex.
- This approach would allow Task Force recommendations to continue with explicit review power by HHS, rather than dismantling the entire system.
5. The Implications of Overturning USPSTF Authority
- The DOJ warns that a broad ruling against USPSTF could throw many other federal health advisory bodies into legal uncertainty, such as the Advisory Committee on Immunization Practices (ACIP) and others that influence public health decisions.
- SCOTUS may hesitate to issue a destabilizing decision with widespread consequences beyond preventive care.
Conclusion: DOJ’s Confidence at SCOTUS
- While Braidwood has won in lower courts, the DOJ sees SCOTUS as more likely to apply precedent that favors the government—especially since the at-will removal authority and HHS oversight are clear on paper.
- The Fifth Circuit’s failure to sever the problematic statute gives SCOTUS a clean path to fix the issue rather than striking down USPSTF’s role entirely.
These factors make the DOJ optimistic that SCOTUS will side with them and uphold the USPSTF’s authority—or at least provide a limited ruling that avoids dismantling the ACA’s preventive care mandate.
