On Friday, the U.S. Supreme Court agreed to examine the legality of a crucial component of the Affordable Care Act (ACA), which empowers a task force established under the landmark healthcare law, commonly known as Obamacare, to mandate that insurers cover preventive medical services at no cost to patients. This decision marks another pivotal moment for the ACA, as Democratic President Joe Biden’s administration seeks to overturn a lower court ruling favoring Christian businesses that oppose certain healthcare mandates on religious grounds.
The Legal Battle Over Preventive Care
The case stems from an appeal by President Biden’s administration following a ruling by the New Orleans-based 5th U.S. Circuit Court of Appeals. This court sided with a group of Christian businesses that objected to their employee health plans covering HIV-preventing medication, claiming the ACA task force’s structure violated the U.S. Constitution. The businesses argued that the task force’s members, who are not removable by the president, infringe upon presidential authority under the appointments clause.
The Justice Department has warned that the 5th Circuit’s ruling could jeopardize critical preventive care services, such as cancer screenings, which millions of Americans currently receive. This ruling adds to a series of court decisions in recent years challenging the constitutionality of various executive branch structures, including those upheld by the conservative-majority Supreme Court.
Historical Context and Current Implications
This legal challenge is part of a broader, ongoing effort by Republicans and conservative groups to dismantle the ACA through legislative and judicial means. Notably, the Supreme Court has upheld the ACA three times since its enactment in 2010, including a 2021 decision rejecting an attempt by Republican-led states to invalidate the law.
The latest case, initiated by America First Legal—a group founded by Stephen Miller, whom President-elect Donald Trump has chosen as his deputy chief of staff for policy—focuses specifically on the preventive care mandate. The plaintiffs, a group of Texas small businesses, object to the requirement that their employee health plans cover pre-exposure prophylaxis against HIV (PrEP) for free, citing religious objections.
Constitutional Questions and Potential Outcomes
U.S. District Judge Reed O’Connor initially blocked the enforcement of the federal preventive care mandate nationwide. However, the 5th Circuit partly reversed this decision, limiting the injunction to the plaintiffs and affirming the unconstitutional structure of the U.S. Preventive Services Task Force. The court ruled that because the task force exercises “unreviewable power,” its members should have been nominated by the president and confirmed by the Senate, which was not the case.
The Biden administration argues that the Health and Human Services (HHS) secretary retains the authority to remove and supervise task force members, countering the 5th Circuit’s conclusion. Even if the task force were insulated from supervision, the administration suggests that the issue could be resolved by severing a single provision of the healthcare law rather than dismantling the entire preventive care mandate.
The Supreme Court is expected to hear arguments and deliver a ruling by the end of June, potentially shaping the future of preventive healthcare services for millions of Americans.
