Supreme Court Gives Obama Victory Over Trump

The Supreme Court appeared open Monday to upholding the constitutionality of a key Affordable Care Act provision requiring insurance companies to cover certain preventive services recommended by a panel of medical experts. The case, years in the making, centers on whether the U.S. Preventive Services Task Force responsible for determining which services should be covered operates with enough executive oversight to pass constitutional muster.

Justices Brett Kavanaugh and Amy Coney Barrett signaled they may lean toward backing the government’s defense of the current structure, though their questions left some ambiguity. The task force, created by the health law and made up of volunteer medical professionals appointed by the Health and Human Services secretary, recommends services like cancer screenings and HIV-prevention drugs. Its recommendations with an A or B grade must be covered by insurers at no cost to patients.

Challengers to the law include a group of conservative individuals and employers from Texas. They argue that the task force is unconstitutional because its members, who wield significant influence over insurance requirements, are not appointed by the president or confirmed by the Senate. A federal appeals court in New Orleans agreed in part, but limited its ruling to the specific plaintiffs.

The Trump administration, despite its broader opposition to ObamaCare, has continued to defend the law’s preventive care mandate in court. During oral arguments, Principal Deputy Solicitor General Hashim Mooppan argued that while the task force is designed to be insulated from political interference, the health secretary still has the authority to remove its members, and therefore retains sufficient oversight.

Mooppan further contended that if the court found that oversight lacking, it could sever the portion of the law requiring political independence, thus allowing the secretary to formally approve or reject the panel’s recommendations.

Justice Elena Kagan pushed back on the challengers’ reading of “independence,” suggesting their argument relied on an overly expansive interpretation of that term. Conservative attorney Jonathan Mitchell, representing the challengers, maintained that true independence would be compromised if members could be removed at will, calling the statute’s language incompatible with broad executive authority.

Barrett described that interpretation as “maximalist,” drawing an analogy to law clerks who provide judges their candid opinions free of political pressure, even though the judges ultimately decide what arguments to pursue.

Kagan and Kavanaugh questioned why the task force should be treated as if it were a powerful agency operating without oversight. Kagan noted that the court has more often reduced the power of independent agencies rather than bolstered them. She found it inconsistent to read a statute that doesn’t explicitly create such an agency as doing so.

Kavanaugh added that if Congress had intended to create an agency more powerful than the HHS secretary or president, there would be clearer statutory language to that effect. He seemed unconvinced the task force held such sweeping authority.

A final ruling is expected in June. Even if the court upholds the constitutionality of the task force, larger questions remain particularly surrounding how much influence Health and Human Services Secretary Robert F. Kennedy Jr. might exert over preventive care recommendations going forward.

While some public health experts worry a ruling in favor of the government could give Kennedy greater control, attorney Richard Hughes IV believes the real risk lies elsewhere. He suggested Kennedy is more likely to focus on issues like vaccines than on routine screenings or HIV prevention, which have far less political controversy.

From Hughes’ perspective, screenings like those recommended by the task force are broadly supported by medical professionals and unlikely to be the focus of significant pushback, even under an administration known for taking more combative stances on public health policy.