The future of a critical provision of the Affordable Care Act, which ensures free access to preventive health care services, hinges on two U.S. Supreme Court justices appointed by President Donald Trump. During recent oral arguments in the case of Kennedy v. Braidwood Management, Justices Brett Kavanaugh and Amy Coney Barrett expressed doubts about a legal challenge that could dismantle no-cost insurance coverage for preventive services, including HIV prevention medication known as PrEP, cancer screenings, and contraception.
Although the lawsuit was initiated during the Biden administration, it is now being defended by President Trump’s administration, adding an unexpected twist to a case with significant implications for public health and LGBTQ+ communities. Central to the case is the U.S. Preventive Services Task Force, an independent panel of medical experts whose recommendations determine covered services under the ACA at no cost to patients.
Conservative Christian business owners, represented by attorney Jonathan Mitchell—known for his previous work with Trump—argue that the Task Force’s authority is unconstitutional due to a lack of Senate confirmation and inadequate oversight. However, during the court proceedings, Justices Kavanaugh and Barrett appeared unconvinced by these arguments.
Trump administration attorney Hashim Mooppan defended the ACA’s structure by highlighting the broad supervisory powers of the Secretary of Health and Human Services. He emphasized that “at-will removal gives the Secretary the power to influence the content of recommendations before they’re made.” Justice Kavanaugh seemed to agree, signaling support for this perspective.
Justice Barrett critiqued Mitchell’s assertion that the term “independent” in the statute implies the Task Force should operate without oversight. She described his argument as “maximalist” and related it to her own judicial experience, illustrating how oversight does not preclude independence. Justice Sonia Sotomayor echoed this sentiment, noting that independence in analysis does not equate to the absence of ultimate authority.
The lawsuit originated as a religious objection to PrEP and has since evolved into a broader challenge against the ACA’s preventive care assurances. Advocates for LGBTQ+ and public health warn that a ruling in favor of the plaintiffs could permit insurers to deny or charge for services currently provided without cost, including STI testing, diabetes screening, contraception, and maternal care.
While Justices Clarence Thomas, Samuel Alito, and Neil Gorsuch appeared sympathetic to the arguments presented by Mitchell, the inquiries from Justices Barrett and Kavanaugh suggest a potential five-justice majority—alongside the Court’s three liberal members—favoring the preservation of preventive care coverage. Mitchell, known for drafting Texas’s 2021 abortion law, has openly aimed to dismantle both LGBTQ+ protections and ACA mandates. In this case, his clients have claimed that coverage for PrEP “encourages homosexual behavior.”
A decision in this pivotal case is anticipated by late June.