Free Preventive Care: A Crossroads for American Health
By Darius Spearman (africanelements)
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Preserving Preventive Care
On June 26, 2025, the United States Supreme Court delivered a significant 6-3 ruling. This decision upheld a vital provision of the Affordable Care Act (ACA), ensuring that free preventive care remains available to approximately 150 million Americans (The Conversation). The case, known as Kennedy v. Braidwood, represented the fourth major legal challenge to the landmark healthcare law. The Court’s decision, penned by Justice Brett Kavanaugh, affirmed that health insurers must continue to cover preventive services recommended by the U.S. Preventive Services Task Force (USPSTF) without any cost to the patient (The Conversation).
The core of the challenge in Braidwood centered on the appointment of USPSTF members. Plaintiffs argued that these members, who are independent scientific experts, lacked proper authority because they were not appointed by the President and confirmed by the Senate (The Conversation). However, the Supreme Court rejected this argument. The Court ruled that USPSTF members are “inferior” officers and do not require presidential appointment, confirming that the Health and Human Services (HHS) Secretary has the authority to appoint them (CNN.com). While this ruling appears to secure access to essential preventive care, it also raises significant concerns about potential political influence over the USPSTF and its recommendations, especially with Robert F. Kennedy Jr. currently serving as the HHS Secretary (The Conversation).
The ACA’s Healthcare Promise
The Affordable Care Act (ACA), often called Obamacare, is a comprehensive healthcare reform law enacted in 2010. Its main goals are to expand health insurance coverage, make healthcare more affordable, and improve the overall quality of care in the United States (KFF). A crucial part of the ACA is its requirement for most private health plans to cover specific preventive services without cost-sharing. This means individuals do not have to pay deductibles, co-payments, or co-insurance for these services (KFF).
This provision is incredibly important because it removes financial barriers that might stop people from getting necessary preventive care. For many Black Americans, who have historically faced significant disparities in healthcare access and outcomes, this free access can be life-changing. It encourages earlier detection and treatment of health issues, which can lead to better health for individuals and potentially lower long-term healthcare costs for the system. In 2020 alone, over 151 million non-elderly adults with private insurance gained access to preventive services without cost-sharing because of the ACA (SHVS.org). This widespread benefit highlights the ACA’s impact on public health across the nation.
Who Benefits from Free Preventive Care?
Guardians of Health: The USPSTF
The U.S. Preventive Services Task Force (USPSTF) is an independent group of national experts. These volunteers specialize in disease prevention and evidence-based medicine (KFF). Their primary role is to enhance the health of people nationwide by providing recommendations on clinical preventive services grounded in robust evidence (KFF). These recommendations are very important because, thanks to the ACA, private health insurers must cover preventive services that the USPSTF gives an “A” or “B” grade. These grades indicate that there is strong evidence to support the effectiveness of the service.
The USPSTF’s work directly affects the coverage of healthcare services for millions of Americans. They review clinical and policy evidence regularly to make new recommendations and update old ones (The Conversation). These services include a wide range of health screenings and interventions. Examples include mammograms for breast cancer, screenings for blood pressure, colon cancer, diabetes, and osteoporosis, and HIV prevention (The Conversation). The USPSTF is one of three federal groups whose recommendations insurers must follow under Section 2713 of the ACA. The other two are the Advisory Committee on Immunization Practices (ACIP) and the Health Resources and Services Administration (HRSA) (The Conversation). For instance, this provision was used to ensure free COVID-19 vaccines for many Americans through the coronavirus relief bill in March 2020 (The Conversation).
Unpacking “Inferior Officers”
The U.S. Constitution, in Article II, Section 2, Clause 2, includes what is known as the Appointments Clause. This clause outlines the process for appointing federal officers. Generally, “principal officers” must be nominated by the President and then confirmed by the Senate. However, Congress has the power to allow “inferior officers” to be appointed in other ways. They can be appointed by the President alone, by courts, or by the heads of government departments (SHVS.org). This distinction was central to the *Braidwood* case.
The lawsuit argued that USPSTF members were “principal officers.” Therefore, their appointment by the Director of the Agency for Healthcare Research and Quality (AHRQ), rather than by the President with Senate confirmation, was unconstitutional (The Conversation). If the Supreme Court had agreed with this argument, it could have invalidated all USPSTF recommendations made since the ACA became law. This would have meant private insurers would no longer be required to cover these services without cost-sharing. However, the Department of Justice (DOJ) argued that USPSTF members are “inferior officers” because the Secretary of Health and Human Services (HHS) has enough oversight. This oversight includes the power to remove members at any time and to review their recommendations (SHVS.org). The Supreme Court ultimately sided with the government, affirming that the HHS Secretary’s control over the task force and its recommendations makes its members “inferior officers” (Statnews.com).
The Braidwood Case: Access Under Fire
The Braidwood case began in Texas in 2020. Braidwood Management, a Christian for-profit corporation, and other plaintiffs filed it. They argued on religious grounds that they should not be forced to offer pre-exposure prophylaxis, or PrEP, in their insurance plans (The Conversation). PrEP is a medicine that helps prevent HIV infection. For Black communities, who are disproportionately affected by HIV, access to PrEP is a critical tool for prevention and health equity. The lawsuit questioned the constitutional appointment of USPSTF members and whether their recommendations made after March 2010, when the ACA was enacted, were valid (The Conversation).
The implications of the *Braidwood* case were far-reaching. If the Court had ruled in favor of Braidwood, private health insurers would no longer have been required to cover, without cost-sharing, preventive services recommended by USPSTF after 2010 (KFF). This would have meant that services and medications like statins to prevent heart disease, lung cancer screening, and PrEP for HIV prevention could have become subject to co-pays, deductibles, or co-insurance (KFF). Such changes could have created significant financial barriers, potentially stopping many people, especially those in communities already facing economic hardship, from accessing these vital services. While the Supreme Court’s decision preserved the free coverage, the case highlighted the ongoing vulnerability of these essential health benefits.
Potential Impact of a Different Braidwood Ruling (If it had gone the other way)
Removing Barriers: The Power of No Cost-Sharing
Cost-sharing refers to the part of healthcare costs that individuals pay out of their own pocket, even when they have health insurance (KFF). This typically includes deductibles, which are amounts you must pay before your insurance starts covering costs. It also includes co-payments, which are fixed amounts you pay for a covered service, and co-insurance, which is a percentage of the cost you pay after meeting your deductible. The Affordable Care Act eliminated these cost-sharing requirements for recommended preventive services (KFF).
This elimination of cost-sharing is incredibly significant because it removes financial hurdles that might otherwise prevent people from seeking crucial preventive care. Many individuals, especially those in underserved communities, might skip important screenings or vaccinations if they have to pay for them. By making these services free, the ACA encourages people to get the care they need, leading to earlier detection of diseases and better health outcomes. This is particularly beneficial for Black Americans, who often face economic disadvantages that can make even small co-pays a barrier to care. If the *Braidwood* ruling had gone the other way, individuals might have had to pay something for affected preventive services, as insurers would review what is covered and by how much (KFF). This could have reversed years of progress in making healthcare more accessible.
Political Shadows: RFK Jr.’s Influence
While the USPSTF is designed to operate independently of political influence, its members are appointed by the HHS Secretary, who can remove them at any time (The Conversation). The Department of Justice (DOJ) has even argued that the HHS Secretary has the final say on whether USPSTF recommendations become legally binding and can deny them legal force (SHVS.org). This level of oversight, while asserted by the government to justify the “inferior officer” status, also highlights a potential vulnerability for the task force’s independence. Robert F. Kennedy Jr., the current HHS Secretary under President Donald Trump, has already demonstrated a willingness to exercise this authority in ways that raise concerns among public health experts.
Kennedy recently took the unusual step of removing all members of the Advisory Committee on Immunization Practices (ACIP) (The Conversation). He replaced them with individuals who include vaccine skeptics. This new committee has already moved to rescind some vaccine recommendations, such as routine COVID-19 vaccines for pregnant women and children (The Conversation). Additionally, Kennedy has proposed restructuring the Agency for Healthcare Research and Quality (AHRQ), which supports the USPSTF, leading to significant layoffs within HHS (The Conversation). Critics fear that the HHS Secretary could replace existing USPSTF members with individuals who might reshape recommended care based on “debunked science and misinformation” (The Conversation). This could lead to worse health outcomes for Americans, especially for Black communities who often rely heavily on evidence-based public health guidelines due to systemic healthcare inequities.
Supreme Court’s Decision in Kennedy v. Braidwood
Future of Health Equity
The Supreme Court’s decision to preserve free preventive care under the ACA is a victory for millions of Americans. This is especially true for Black communities, who often face systemic barriers to healthcare access and disproportionately suffer from chronic diseases that could be prevented or managed with early intervention. The ability to receive screenings for conditions like diabetes, high blood pressure, and various cancers without out-of-pocket costs is crucial for promoting health equity and reducing health disparities.
However, the ruling also highlights a delicate balance. While the USPSTF’s recommendations are rooted in scientific evidence, the increased power of the HHS Secretary to influence or even reshape these recommendations introduces a new layer of risk. If future secretaries choose to prioritize political agendas over scientific consensus, it could undermine the very foundation of evidence-based preventive care. This could lead to a rollback of essential services or the promotion of unproven methods, which would severely impact the health and well-being of all Americans, particularly those who are already vulnerable and rely on these protections the most.
A Crossroads for American Health
The Supreme Court’s ruling in *Kennedy v. Braidwood* has secured free preventive care for now. This is a significant win for the health of approximately 150 million Americans. The decision affirmed the legal standing of the USPSTF and its recommendations, ensuring that vital services like cancer screenings, diabetes prevention, and HIV PrEP remain accessible without financial barriers. This is particularly important for communities of color, who have historically faced greater challenges in accessing quality healthcare.
Nevertheless, the ruling also reveals a potential vulnerability. It underscores the considerable power held by the HHS Secretary over the USPSTF and its future recommendations. The actions of the current HHS Secretary, Robert F. Kennedy Jr., regarding other advisory committees and agencies, signal a potential for increased political influence over scientific bodies. This raises concerns that future recommendations could be swayed by non-scientific considerations, potentially eroding trust in public health institutions and jeopardizing access to life-saving care. The path forward for American health will depend on how this power is exercised and whether the commitment to evidence-based preventive care remains steadfast.
ABOUT THE AUTHOR
Darius Spearman has been a professor of Black Studies at San Diego City College since 2007. He is the author of several books, including Between The Color Lines: A History of African Americans on the California Frontier Through 1890. You can visit Darius online at africanelements.org.
