Introduction to the United States Preventive Services Task Force (USPSTF)

Preventive care services help to detect and prevent serious illnesses, and ensuring people can access them without cost-sharing is essential. The Affordable Care Act (ACA) (enacted on March 23, 2010) has been key to increasing health care access and making health coverage more affordable. It also included innovative strategies to lower the cost of certain health care services—including preventive services. The ACA requires all eligible private health insurance plans to cover a range of preventive services at no-cost to patients. Specifically, the ACA says that insurance must cover:

1. Vaccine recommendations from the Advisory Committee on Immunization Practices (ACIP);
2. Pediatric and women’s preventive services and screenings established in guidelines by the Health Resources and Services Administration (HRSA) and currently informed by the Women’s Preventive Services Initiative (WPSI); and
3. Recommendations with an “A” or “B” rating from the United States Preventive Services Task Force.

The US Preventive Services Task Force (“USPSTF”), an all-volunteer, independent entity made up of experts in preventive medicine, was convened in 1984 by the Department of Health and Human Services. The Task Force issues a letter grade (A, B, C, D, or I—with A indicating a high recommendation rating, D recommending against the service, and I noting insufficient evidence) to preventive services based on evidence of documented benefits and harms (moderate to substantial).

What Preventive Services Are At Risk?

As of April 2025, the USPSTF has fifty-four services rated “A” or “B.” If the Supreme Court rules that USPSTF members were unconstitutionally appointed, it would jeopardize vital no-cost preventive care services for women. The services at risk include:

• HIV prevention through prescription of pre-exposure prophylaxis (PrEP);
• Screening for lung cancer and colorectal cancer;
• Screening for substance use disorder (SUD);
• Preventive interventions for perinatal depression;
• Medications to reduce breast cancer risk for women 35 years or older;
• Screening for chlamydia and gonorrhea for women 25 years and older at increased risk of infection;
• Screening for Hepatitis C;
• Preeclampsia prevention through prescription of low-dose aspirin for those at high risk and;
• Healthy diet and activity counseling for those considered overweight and obese;
• Note: This will not affect counseling for those between 40 and 60 years old.

Case History

In 2022, Braidwood Management Inc. and six individuals from Texas sued then-Secretary of Health and Human Services, Xavier Beccera, arguing first that the U.S. Preventive Services Task Force (USPSTF) recommendations were invalid because the experts on the Task Force were not properly appointed under the U.S. Constitution. Braidwood argued that under the Appointments Clause, the members of USPSTF should be approved by the Senate. Secondly, Braidwood argued that the requirement to cover pre-exposure prophylaxis (PrEP) violates their religious freedom.

The Northern District of Texas ruled that (1) the members of USPSTF were unconstitutionally appointed and (2) that the requirement to cover PrEP for HIV prevention violated the religious freedom of Braidwood Management. The lower court issued a nationwide injunction, preventing them from enforcing coverage of no-cost preventive services that were rated “A” or “B” by USPSTF.

The case was appealed to the Fifth Circuit, which also held that the members of USPSTF were unconstitutionally appointed; however, it did not agree that a nationwide injunction was appropriate. The Fifth Circuit reversed the nationwide injunction, and instead held that only Braidwood Management and the other members who brought the case were not subject to the recommendations from USPSTF.

The case was then appealed to the Supreme Court, where the Court will decide whether members of the USPSTF were constitutionally appointed under the Appointments Clause.

Preventive Services Are Critical for Women

The Supreme Court’s decision in Braidwood has the potential to impact coverage of no-cost preventive care for over 150 million people with private health insurance, including over 58 million women. Women are 35 percent more likely than men to report that they have skipped or delayed medical care in a 12-month period. Delays in medical care can often lead to worsening of conditions and increased costs down the line. The types of treatment that women are more likely to delay include acute illness and preventive services, such as cancer screenings. Preventive cancer screenings save lives as advanced cancers generally require more extensive and comprehensive treatments and have worse health outcomes.

Preventive services like screenings and prescription medications are also essential in responding to diseases like HIV. Since the 1980s, the overall number of those diagnosed with HIV has decreased due in part to preventive measures like prescriptions of pre-exposure prophylaxis (PrEP), yet disparities in access to this preventive care remain. In 2022, Black women accounted for half of new HIV diagnoses of women in the United States, and are currently the largest percentage of women living with HIV. Black women already face substantial barriers, including marketing that does not highlight the benefits of PrEP for Black women, stigma, discrimination, and medical mistrust when accessing PrEP for HIV prevention. Adding cost-sharing to this medication would only increase barriers.

Access to no-cost preventive services is essential to promoting women’s health and decreasing health disparities. We hope the Court will uphold the constitutionality of USPSTF and stop this effort to overturn coverage of critical preventive services. After 15 years of constant attacks on the ACA, this obscure legal challenge has the potential to take away vital preventive care that people have grown to depend on.