The dispute over the U.S. Preventive Services Task Force threatens free access to a wide range of services used by tens of millions of Americans under Obamacare.

The Supreme Court on Monday will consider the legality of a government panel that makes it possible for Americans to receive preventive health care at no cost, including disease screening and drugs to protect women during pregnancy.

The case began with a Christian employer who objected to a mandate that the company’s insurance plan must cover an HIV prevention drug recommended primarily for gay and bisexual men. The requirement was based on a decision by the U.S. Preventive Services Task Force.

But the legal challenge evolved into one with much broader implications, threatening free access to a wide range of services used by tens of millions of Americans, according to legal scholars and health experts. They include cancer screening, counseling for expectant mothers at risk for perinatal depression and cholesterol-lowering medication to prevent heart disease.

Georges Benjamin, executive director of the American Public Health Association, said a decision by the Supreme Court to back the challengers could mean “more cancer, more heart disease, more strokes, more complications from pregnancy, more drug misuse and, frankly, more preventable deaths.”

The Kennedy v. Braidwood Management case before the court takes aim at the role of the task force of medical experts that has recommended that dozens of preventive care services be covered by insurers at no cost to patients under the Affordable Care Act. The 2010 law, known as Obamacare, has long been a target of conservatives.

Congress designed the task force to be “independent and, to the extent practicable, not subject to political pressure.” The panel’s 16 members, who serve four-year terms, are appointed by the health and human services secretary. The secretary also has the power to decide when the panel’s recommendations are binding on insurers.

Courts are scrutinizing whether the panel is too powerful.

In 2023, U.S. District Judge Reed O’Connor of Texas, who seven years ago struck down the entire ACA but was overturned by the Supreme Court, ruled the task force was unconstitutional because its members were not properly chosen under the Constitution’s appointments clause. Officials with significant executive power, he said, must be nominated by the president and confirmed by the Senate.

The conservative U.S. Court of Appeals for the 5th Circuit agreed, finding that the panel’s recommendations on legally mandated coverage are “unreviewable” by a higher-ranking official, in large part because Congress intended to ensure the panel’s independence.

The case comes as President Donald Trump is working to seize greater control over the federal bureaucracy by firing independent regulators and government watchdogs. But in this case, the Trump administration, like the Biden administration before it, is backing the task force because it contends panel members can be fired at any time, for any reason, by the HHS secretary.

The secretary’s “ability to remove Task Force members after the fact provides a powerful tool to influence their recommendations in the first place,” Solicitor General D. John Sauer said in a court filing ahead of Monday’s argument.

The lawyer for the challengers, Jonathan Mitchell, said the Trump administration’s position is contradictory and must be rejected by the Supreme Court.

If the HHS secretary can remove task force members for any reason, “and if the secretary can use his at-will removal powers to influence the task force and its recommendations,” Mitchell wrote in a court filing, “then the task force is no longer ‘independent’ under any plausible interpretation of that word.”

The Supreme Court case is limited to a question of proper bureaucratic procedure and not the religious freedom issues raised by the challengers. They assert the insurance mandates to cover HIV pre-exposure prophylaxis (PrEP) medication conflict with their religious beliefs because the drugs “encourage and facilitate homosexual behavior.”

Jeremiah Johnson, executive director of PrEP4All, which advocates for increased access to those drugs, said the case provides “a classic example where an attack on one subset of the population really can translate to attacks on protections for all Americans.”

The preventive care section of the ACA is one of the most popular parts of the law, public opinion polling has shown. More than 8 in 10 adults had a favorable view of the provision, regardless of political party, according to a 2023 KFF health tracking poll.

A recently published study estimated at least 39 million people, or 30 percent of people with private health insurance, use at least one of the 10 services most jeopardized by the lawsuit.

The most widely received services identified in the study, which relied on a database of commercial insurance claims, included screenings for cervical cancer, hepatitis C and HIV.

“If guaranteed free service access goes away, a lot of people could lose that financial protection that makes the service affordable,” said Josh Salomon, director of the Stanford Prevention Policy Modeling Lab and senior author of the study.

The loss of preventive health insurance mandates would disproportionately affect women. The Stanford study showed nearly half of women with private health insurance received a free preventive service as a result of the task force’s recommendations.

Dorianne Mason, director of health equity at the National Women’s Law Center, said insurance mandates for preventive care save women’s lives and the health-care system billions of dollars through early detection of breast cancer and medication to reduce the risk of preeclampsia during pregnancy, among other services.

“I don’t think we can understate how important preventive care is, particularly for women who are the folks who deny themselves care and delay care,” Mason said.

“It’s the care that has the biggest bang for your buck,” Mason added. “It’s the care that’s going to prevent the bigger, more difficult to treat, expensive care down the line.”

A Supreme Court decision that finds the design of the task force unconstitutional would not necessarily end free access to preventive care. The court still could salvage the panel by striking just the provision of the law that guarantees independence, while allowing the HHS secretary to oversee its work.

Insurers may also continue to cover at least some of the preventive services, because prevention is often less expensive than medical care for chronic or serious conditions.

But consumer advocates noted prevention was not routinely covered before the passage of the Affordable Care Act. Research has also demonstrated even small co-pays reduce the odds that someone will receive preventive health care.

Public health experts worry a loss at the Supreme Court could jeopardize other government panels that help Americans get free preventive care. Those include the Advisory Committee on Immunization Practices that recommends which vaccines Americans receive free or the Women’s Preventive Services Initiative, which enabled contraception coverage mandates.

The targeting of PrEP, which is at the heart of the lawsuit, comes at a time when researchers and activists are concerned that the elusive goal of ending the HIV epidemic is slipping away.

The Trump administration has canceled funding for studies related to PrEP and grants to organizations that provide it, part of a broader campaign to eliminate federal dollars for “woke” initiatives that also include race and gender identity.

Even with the insurance mandate in place, tens of thousands of people have been forced to pay for PrEP because of problems ranging from incorrect billing codes to the failure of insurance regulators to enforce the rules. Eroding the mandate further, activists say, escalates the risk of thousands of preventable HIV infections.

“We’re in a time of innovation that can truly accelerate progress to end HIV as an epidemic,” said Johnson, the PrEP advocate. “Turning our back on preventive health coverage would be an incredible loss.”

From : https://www.washingtonpost.com/health/2025/04/21/supreme-court-obamacare-aca-healthcare/