Doesn't seem right that the federal government, while it's being sued, gets to pressure the plaintiffs to make a deal out of court.

University of Michigan/Michigan Medical is also weighing in with an interest in the case.

Referenced and linked in today's blog post.

https://mihealthfreedom.org/schizophrenic-state-mental-health-policy/

SCOTUS decides at last.

To clarify, where this report's subtitle refers to "healthcare," it means "Big Insurance."

To clarify further, the great victory for insurance companies is a great loss for affordable access to their products, as well as to employer religious freedom.

I've marked in bold the underlying law in question. Thus far an obscure part of the ACA/Obamacare, it deserves to be better-known.

Many source links available in the original article.

https://www.medpagetoday.com/primarycare/preventivecare/116288

Supreme Court Issues Ruling on ACA's Preventive Care Mandate
— The 6-3 ruling is hailed by one health group as a "great victory for healthcare in our country"

by Joyce Frieden    |    June 27, 2025

The Supreme Court on Friday preserved a key aspect of the Affordable Care Act's (ACA) preventive coverage mandate, handing a defeat to employers who don't want to be required to cover certain preventive care services.

In the 6-3 decision, the Supreme Court ruled that the appointment of members to the U.S. Preventive Services Task Force (USPSTF) is constitutional. "Task force members are inferior officers whose appointment by the secretary of HHS is consistent with the Appointments Clause" of the Constitution, the court wrote in its summary, which was authored by Justice Brett Kavanaugh.

The case, known as Kennedy v. Braidwood, involved Christian-owned businesses and six individuals in Texas who challenged the ACA requirement to cover preventive services, according to an issue brief from KFF, a health policy research and news organization. In particular, the court considered whether the structure of the USPSTF -- an independent entity convened by the federal government that makes recommendations for preventive services -- violates the Appointments Clause.

Under the Appointments Clause, "officers of the United States" may only be appointed by the president, subject to Senate approval. The plaintiffs argue that the USPSTF is unconstitutional because its members are not presidentially appointed or Senate-confirmed. This is relevant because the ACA requires all insurers -- including private insurers and self-insured employers such as those in the lawsuit -- to cover at no charge any preventive services that are recommended by the USPSTF. These include screenings for breast, colon, prostate, and lung cancers; depression; diabetes; obesity; and sexually transmitted infections.

Religious Freedom Argument

In their initial case, filed in 2022, the respondents alleged that the preventive services requirements for private health insurance are unconstitutional and also that the requirement to cover pre-exposure prophylaxis (PrEP) treatment for HIV prevention violates the Religious Freedom Restoration Act. They said they should not have to cover services that their employees don't need or those that the employers object to. The federal government, representing the other side, argued that the USPSTF's oversight by the HHS secretary is constitutionally appropriate because HHS may remove members at will and can determine when health insurance issuers must start providing coverage for new recommendations.

The 5th Circuit Court of Appeals in June 2024 affirmed the district court's ruling that the ACA's requirement to cover services recommended by USPSTF without cost-sharing is unconstitutional. However, they ruled that only the plaintiffs are permitted to exclude USPSTF-recommended services from their plans, KFF explained.

During oral arguments at the High Court on April 21, the word "independence" factored in heavily. "That's an incredibly strained interpretation of the term 'independent,'" Justice Samuel Alito -- one of the dissenters in Friday's ruling -- said to Principal Deputy Solicitor General Hashim Mooppan, who had just made an argument on behalf of the federal government. "Explain to me how somebody can be independent and yet subject to removal [from their position] on the whim of the president."

"It's 'independent' in the sense that they have both the duty and power to exercise their own best judgment," Mooppan said. "That doesn't mean that once they've done so, they're free from accountability. It just means that when they are making the decision, they have an obligation to exercise their best scientific judgment."

Supervision by HHS Secretary

In his conclusion Friday, Kavanaugh noted that "Task force members issue preventive services recommendations of critical importance to patients, doctors, insurers, employers, healthcare organizations, and the American people more broadly. In doing so, however, the task force members remain subject to the secretary of HHS's supervision and direction, and the secretary remains subject to the president's supervision and direction. So under Article II and this court's precedents, task force members are inferior officers, and Congress may vest the power to appoint them in the secretary of HHS."

This interpretation gives HHS Secretary Robert F. Kennedy, Jr. -- who recently fired all 17 members of the CDC's Advisory Committee on Immunization Practices and replaced some of them with others who were known for anti-vaccine views -- the power to hire and fire task force members at will. The decision summary also says that "Beyond at-will removal, the Secretary has statutory authority to directly review and block task force recommendations before they take effect."

"Congress has done so, and the secretary has appointed the task force members pursuant to that grant of authority," he continued. "Therefore, the task force members' appointments are fully consistent with the Appointments Clause in Article II of the Constitution. The structure of the task force and the manner of appointing its officers preserve the chain of political accountability that was central to the Framers' design of the Appointments Clause: The task force members were appointed by and are supervised and directed by the secretary of HHS. And the secretary of HHS, in turn, answers to the president of the United States. We reverse the judgment of the Court of Appeals and remand the case for further proceedings consistent with this opinion."

But three of the justices disagreed. "At the beginning of this suit, a subordinate official within [HHS] had for years appointed the task force's members," Justice Clarence Thomas wrote in his dissenting opinion, in which he was joined by Alito and Justice Neil Gorsuch. "Everyone now agrees that this practice was unlawful ... But, rather than accept that the default mode of appointment applies, the government invented a new theory on appeal, arguing that the combination of two ambiguously worded statutes enacted decades apart establishes that the secretary of HHS can appoint the task force's members."

"I do not see how Congress has spoken with the clarity needed to depart from the default rule established by the Appointments Clause," he continued. "In ruling otherwise, the court treats the default rule as an inconvenient obstacle to be overcome, not a constitutional principle to be honored. And, it distorts Congress's design for the task force, changing it from an independent body that reports directly to the president to one subject to the control of the secretary of HHS."

Health Groups React

Health groups expressed relief at the High Court's ruling. "This is a great victory for healthcare in our country and for everyone who believes in prevention, including the Trump administration," Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, said in a statement. "This legal attack was initiated by extreme right-wing social conservatives who sought to make sure that gay men and others could not access PrEP to prevent HIV. We are very pleased the court upheld the coverage requirement. Now we must focus on making sure insurers comply with and regulators enforce the law, particularly with new, long-acting forms of PrEP."

Families USA, a healthcare consumer group, also applauded the ruling. "The Supreme Court provided some security to over 170 million Americans by preserving their access to the ACA's guarantee that life-saving preventive services will be covered without cost-sharing," Anthony Wright, the group's CEO, said in a statement. "This means most Americans will continue to get screenings for cancer, diabetes, high blood pressure, HIV, depression, intimate partner violence, and substance use disorders as long as the task force's recommendations remain intact."

However, he added, "While this is a foundational victory for patients, patients have reason to be concerned that the decision reaffirms the ability of the HHS secretary, including our current one, to control the membership and recommendations of the USPSTF ... We must be vigilant to ensure Secretary Kennedy does not undo coverage of preventive services by taking actions such as his recent firing of qualified health experts from the CDC's independent vaccine advisory committee and replacing them with his personal allies. For patients to fully benefit from this patient protection, this and future HHS secretaries must commit to follow the nonpartisan, evidence-based advice of doctors and medical professionals in prioritizing the preventive care that provides the best benefit for the public."

And... MedPage reports the next chess move is HHS Sec. Kennedy's.

https://www.medpagetoday.com/washington-watch/washington-watch/116435

Kennedy Abruptly Cancels USPSTF Meeting

— Move raises concern that the task force may face a similar fate as CDC's federal vaccine advisors

July 9, 2025

HHS Secretary Robert F. Kennedy Jr. abruptly cancelled the U.S. Preventive Services Task Force (USPSTF) meeting slated for Thursday, a source with knowledge of the meeting told MedPage Today.

USPSTF was set to discuss diet, physical activity, and weight loss to prevent cardiovascular disease in adults, the source said.

An HHS spokesperson confirmed to MedPage Today that USPSTF "will not be meeting on July 10," but did not give a reason.

The source said that on Monday afternoon, an email went out to all meeting participants. "Moving forward, HHS looks forward to engaging with the Task Force to promote the health and well-being of the American people," the email stated.

This came as a shock, as participants were prepared for the meeting, and travel accommodations had already been booked. There is no known plan to reschedule the meeting, the source said.

Last month, the Supreme Court upheld that appointment of USPSTF members by the HHS Secretary is constitutional, meaning that the Secretary is able to fire and replace members at will. (The decision, Kennedy v. Braidwood, preserved the Affordable Care Act's preventive coverage mandate.)

The source also noted that USPSTF members are concerned that they could be dismissed, just as members of CDC's Advisory Committee on Immunization Practices (ACIP) were ousted last month. Such a move, they say, would be devastating to the health of the public and clinicians who rely on USPSTF guidance.

Georges Benjamin, MD, executive director of the American Public Health Association (APHA), is also concerned about the fate of the panel. One of the USPSTF topics in draft development is on screening for autism spectrum disorder in young children.

"We feared that [Kennedy] would begin, just like he did with ACIP, interfering in other task forces," Benjamin told MedPage Today.

He acknowledged that there may be a valid reason for why the meeting was cancelled, though he thinks that is unlikely.

Rachael Robertson joined the enterprise and investigative team at MedPage Today in March of 2023. Her print, data, and audio stories have appeared in Everyday Health, Gizmodo, the Bronx Times, and multiple podcasts. Rachael is a member of NLGJA, which awarded her a scholarship towards her studies at the Craig Newmark Graduate School of Journalism at CUNY, where she focused on health and science reporting. She got her bachelor’s degree in Communication Arts with a minor in Global Health Studies from Allegheny College. Before journalism, Rachael worked for an elder care program in New York City.