The U.S. Supreme Court has upheld the constitutionality of the U.S. Preventive Services Task Force, saving free PrEP and other preventive treatments, including screenings for cancer, heart disease, and sexually transmitted infections.

Under the Affordable Care Act (ACA), the task force was tasked with identifying which preventive services insurers could cover without passing additional costs to consumers. As a result, insurers began covering a wide range of screenings and treatments, including mammograms, colonoscopies, cancer screenings, heart disease prevention, STI testing, and mental health evaluations.

In a 6-3 decision, the Supreme Court ruled that the task force members are “inferior officers,” meaning they are appointed by, and subordinate to, other government officials — in this case, the U.S. Secretary of Health and Human Services. Under the Appointments Clause of the U.S. Constitution, inferior officers do not have to be confirmed by the U.S. Senate.

“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 [of the Constitution],” Kavanaugh wrote. “Therefore, under Article II and this Court’s precedents, the Task Force members are inferior officers.”

Kavanaugh was joined by Chief Justice John Roberts and Justices Amy Coney Barrett, Sonia Sotomayor, Elena Kagan, and Ketanji Brown Jackson.

Justice Clarence Thomas, joined by Justices Samuel Alito and Neil Gorsuch, raged in a dissenting opinion that the majority’s ruling “treats the default rule as an inconvenient obstacle to be overcome, not a constitutional principle to be honored.”

He argued that Congress initially intended for the task force to report directly to the president, not the HHS Secretary, and argued that the members should be approved by the U.S. Senate before issuing any recommendations.

The lead plaintiff in the lawsuit, Braidwood Management Inc., a Texas-based, Christian-owned company, challenged the task force’s constitutionality, arguing that its members were “principal officers” who should have been confirmed by the U.S. Senate before taking their positions.

Braidwood argued that the task force members’ appointments were unconstitutional and that any decisions they had made regarding which preventive treatments or screenings should be covered by insurance ought to be retroactively nullified.

Braidwood’s primary objection was the task force’s recommendation that insurers provide PrEP — typically taken as a daily oral medication — along with STI testing, at no out-of-pocket cost to patients.

Citing its Christian beliefs, Braidwood claimed that the medication and testing would encourage “immoral conduct,” including extramarital and premarital sex, as well as same-sex relations.

The company argued that, by subsidizing health insurance for its employees, it was being forced to violate its religious conscience by effectively condoning behaviors that make such treatments necessary — including “homosexual behavior, prostitution, sexual promiscuity, and intravenous drug use.”

In 2022, a federal judge in Texas ruled that requiring Braidwood to subsidize PrEP violated its rights under the Religious Freedom Restoration Act. Because that decision applied only to Braidwood, it was never challenged. However, in March 2023, the same judge ruled that insurers were not required to comply with the task force’s recommendations, arguing that its members had been illegally appointed.

The 5th U.S. Circuit Court of Appeals upheld the judge’s 2023 ruling, blocking ACA mandates for insurers as they applied to Braidwood and other similarly situated Christian employers. The Supreme Court’s decision has now reversed that finding.

Had the Court ruled differently, the consequences could have been severe for American health care consumers, potentially forcing them to pay out-of-pocket for any preventive services no longer covered by insurers.

At-risk services would have included mammograms for breast cancer, depression screenings, STI testing, colonoscopies, blood pressure and cholesterol screenings, maternal health care, and childhood immunizations — as well as PrEP.

Advocates praised the court’s ruling, particularly for preserving access to PrEP, a medication widely used by LGBTQ individuals to prevent HIV transmission. 

“This decision means millions of Americans, for now, can breathe easier, knowing that critical preventive care remains within reach — not a luxury reserved for the privileged few,” Kelley Robinson, the president of the Human Rights Campaign, said in a statement.

“While we’re pleased that the Supreme Court has blocked this attempt to create even more burdens on people seeking lifesaving care, we must remain vigilant,” Robinson added. “The HHS, under Secretary Robert F. Kennedy Jr., has exhibited an open hostility toward the health needs of LGTBQ+ people and has already undermined critical protections against HIV. We must continue to work to ensure everyone, no matter your sexual orientation, gender identity, race, income or location, can access the care they need to thrive.”

But advocates warned that future litigation seeking to expand the religious exemption granted to Braidwood could still emerge.

Additionally, the U.S. Department of Health and Human Services, under Secretary Robert F. Kennedy Jr., could attempt to erode coverage through rule-making or executive action — particularly for services the secretary deems unnecessary, or those that benefit the LGBTQ community, whose visibility and legal protections the Trump administration previously sought to restrict.

“In recent weeks, Secretary Robert F. Kennedy Jr. purged the CDC’s Advisory Committee on Immunization Practices — a clear warning sign of how vulnerable preventive health policy is under his leadership,” Elizabeth G. Taylor, the executive director of the National Health Law Program, said in a statement. “The potential for politicization and the rejection of scientific consensus under this administration pose an ongoing threat to the very services this ruling just preserved.”

U.S. Rep. Mark Takano (D-Calif.), chair of the Congressional Equality Caucus, said the court’s ruling correctly upheld the constitutionality of the task force, directly opposing what he called the Trump administration’s “politicization of the government’s scientific bodies that are designed to protect public health.”

“After several terrible, anti-LGBTQI+ rulings, the Supreme Court today got at least one thing right,” Takano said, “and both LGBTQI+ people’s and the wider public’s health will be safer because of it.”