Supreme Court Affirms RFK Jr.’s Power Over What Health Insurance Is Required to Cover

Yes, the justices upheld a key part of the Affordable Care Act, but they also said our conspiracy theorist Health Secretary can determine which preventive services are covered with no out-of-pocket costs.

By Susan Rinkunas | June 27, 2025 | 12:51pm

Photo: Getty Images Politics

Supreme Court Affirms RFK Jr.’s Power Over What Health Insurance Is Required to Cover

On Friday, the Supreme Court upheld the Affordable Care Act’s preventive care task force, a body that recommends which preventive services insurance has to cover with no out-of-pocket costs. But it also underscored just how much power Health Secretary Robert F. Kennedy Jr. has over people’s health insurance coverage.

The ruling was 6-3 with Justices Clarence Thomas, Samuel Alito, and Neil Gorsuch dissenting. Thomas wrote that he believes the task force is unconstitutional, saying that members should be appointed by the President and approved by the Senate.

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The case, Kennedy v. Braidwood Management, Inc., began in 2020 when Christian business owners in Texas sued the Department of Health and Human Services by claiming that the U.S. Preventive Services Task Force is unconstitutional. The USPSTF is an expert panel that recommends to HHS which health care services should be fully covered without cost-sharing—that is, copays, deductibles, or coinsurance. The plaintiffs, represented by right-wing legal activist Jonathan Mitchell, objected on religious grounds to their health plans covering HIV prevention drugs called PrEP and claimed the panel doesn’t have legal authority to advise HHS. (The USPSTF also recommends lung and colon cancer screenings, statins to prevent heart disease, and medications to prevent breast cancer.)

Justice Brett Kavanaugh wrote for the court that this panel is constitutional, but that Kennedy could fire its members at any time. “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,” he said. Kavanaugh added that if a USPSTF member makes a recommendation that Kennedy disagrees with, he can fire them.

This removal power, combined with the Secretary’s ability to delay when panel recommendations become binding, essentially allows Kennedy to block recommendations he disagrees with until he can replace people on the panel. “The Secretary can block a Task Force recommendation from taking effect by combining his at-will removal authority with his authority to determine when Task Force recommendations become binding,” Kavanaugh wrote.

In its second decision of the day, the Supreme Court UPHOLDS the Preventive Services Task Force, which decides which treatments must be fully covered by health insurance …But the court also clarifies that RFK Jr. has power to remove its members at-will. www.supremecourt.gov/opinions/24p…

— Mark Joseph Stern (@mjsdc.bsky.social) 2025-06-27T14:32:59.823Z

Kennedy just exercised this power with the Centers for Disease Control and Prevention’s vaccine advisory panel. Earlier this month, he fired all 17 members and then appointed his own people, including a slew of vaccine skeptics. Then on Thursday, the panel recommended that people in the U.S. shouldn’t receive a flu vaccine that contains a specific preservative.

If Kennedy appoints people who will stop recommending certain preventive services, that means insurance companies could slap on added costs, which could lead people to delay seeing their doctor and suffer worse health outcomes. It could also lead to more profits for insurance and pharmaceutical companies. The employer plaintiffs sued because they didn’t want to cover PrEP for HIV and, after the ruling, there was a rise in the stock price of Gilead, the pharmaceutical company that markets the branded PrEP drugs Biktarvy and Descovy. This is a truly vile development.

Gilead shares rise after US top court ruling on preventative coverage reut.rs/45JJ49F

— Reuters (@reuters.com) 2025-06-27T15:05:11Z

As Laurie Sobel, an associate director for women’s health policy at KFF, told NBC News ahead of the April arguments: “Even a ruling in favor of the federal government doesn’t necessarily assure that the preventative services will remain how they are right now.”

While the Affordable Care Act also requires prescription birth control to be covered without cost-sharing, today’s ruling doesn’t immediately impact the contraception mandate. That’s because a different advisory panel is in charge of recommendations related to women’s health, known as the Women’s Preventive Services Initiative. The WPSI recommends insurers cover contraception, STI screening, cervical cancer screening, and more. (It’s housed under an HHS sub-agency called Health Resources and Services Administration.)

But the birth control part of this case isn’t technically over yet: a Texas judge is still considering the Braidwood plaintiffs’ claim that the Health Department didn’t follow federal law when ratifying the WPSI’s preventive service recommendations for women. Litigation over that issue could come back to the court at a later date.

Still, the Trump administration is already attacking birth control. In April, it paused millions of dollars in federal grants that help low-income people access contraception. The same month, Alliance Defending Freedom, a far-right law firm that helped topple Roe v. Wade, urged the Health Department to cut ties with a top medical group that reviews insurance coverage of women’s health services—including birth control. ADF urged Kennedy to kick the American College of Obstetricians and Gynecologists off the WSPI panel; Kennedy has not yet responded.

Friday’s decision came one day after the justices allowed states to “defund” Planned Parenthood. Today marks the end of the term, which also saw the conservatives upholding a ban on youth gender-affirming care, letting parents object to LGBTQ books in classrooms, and limiting nationwide injunctions. The court will not hear arguments again until October.

We are in the bad place.

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