The U.S. Preventive Services Task Force

The future of preventive health services, patient cost-sharing, and impact to public health

In the complex landscape of American health care, few entities have had as significant an impact on preventive medicine as the United States Preventive Services Task Force (USPSTF). Created to provide evidence-based recommendations for preventive services, this independent panel now finds itself at the center of a constitutional challenge that could dramatically alter health care access for hundreds of millions of Americans. This article examines the USPSTF's origins, its crucial role in health care delivery, and the implications of the recent Supreme Court case that threatens to undermine its authority.

As a brief aside, I got to sit in on Supreme Court oral arguments this week and it was an incredible experience. One of the privileges of living in DC is the ability to witness the functions of American government in person. What may seem like a “black-box” to most, the processes of government are actually very accessible and open to the public.

The Origins of the USPSTF

The USPSTF was established in 1984 as a response to the growing need for standardized, science-based guidance on preventive health care services. Modeled after the Canadian Task Force on Preventive Health Care (established in 1976), the USPSTF was initially created as a five-year project to "develop recommendations for primary care clinicians on the appropriate content of periodic health examinations." What began as a temporary initiative evolved into a cornerstone of American preventive medicine.

The Task Force is comprised of 16 volunteer experts from fields including internal medicine, family medicine, pediatrics, health services research, behavioral health, obstetrics and gynecology, and nursing. These volunteers serve four-year terms and are appointed by the Director of the Agency for Healthcare Research and Quality (AHRQ). Crucially, members must have no substantial conflicts of interest that could compromise the integrity of the Task Force's work. This independence is designed to ensure that recommendations are based solely on scientific evidence rather than political or commercial interests.

The Task Force describes itself as "an independent, volunteer panel of national experts in disease prevention and evidence-based medicine" that "works to improve the health of people nationwide by making evidence-based recommendations about clinical preventive services." This mission places the USPSTF at the intersection of scientific research and clinical practice, serving as a trusted interpreter of complex medical evidence for health care providers nationwide.

How the USPSTF Shapes Care Delivery in the US

The USPSTF's work revolves around rigorous, systematic reviews of scientific evidence regarding preventive health services. In evaluating a preventive service, the Task Force assesses both potential benefits (such as early disease identification and improved health outcomes) and potential harms (including adverse effects, inaccurate test results, unnecessary additional testing, or unneeded treatment). This methodical approach considers not just whether a preventive service works, but whether it provides a net benefit to patients.

Based on this evaluation, the USPSTF assigns each preventive service a letter grade:

• "A" grade: Strong recommendation; high certainty of substantial net benefit

• "B" grade: Recommendation; moderate to high certainty of moderate to substantial net benefit

• "C" grade: Selective offering based on professional judgment and patient preferences

• "D" grade: Recommendation against; moderate to high certainty of no net benefit or harms outweigh benefits

• "I" statement: Insufficient evidence to assess benefits versus harms

These ratings might seem academic, but they carry enormous practical implications, particularly since the passage of the Patient Protection and Affordable Care Act (ACA) in 2010. Under Section 2713 of the ACA, private health insurance plans must cover "evidence-based items or services that have in effect a rating of 'A' or 'B' in the current recommendations of the United States Preventive Services Task Force" without imposing cost-sharing requirements on patients. This means no co-pays, deductible hits, or co-insurance for these services. This provision transformed USPSTF recommendations from clinical guidance and merely informational to insurance coverage mandates, significantly expanding access to preventive care.

The scope of this impact is substantial. The preventive services coverage requirement applies to most private health insurance plans in the individual, small group, and large group markets, except for "grandfathered" plans that existed before the ACA. This means more than 150 million Americans with private health insurance have benefited from guaranteed access to recommended preventive services without facing deductibles, copayments, or coinsurance.

The range of covered services is extensive, including:

• Cancer screenings (breast, cervical, colorectal, lung)

• Cardiovascular disease prevention (cholesterol screening, statins for heart disease)

• Diabetes screening

• Depression screening

• Tobacco cessation

• HIV prevention and screening

• Hepatitis screenings

• Intimate partner violence screening

• Immunizations

• Prenatal care

The removal of financial barriers to these services has potentially positive effects. One systematic review produced the following conclusions:

“The published literature shows consistent impacts of higher cost sharing on initiation and continuation of medications, and the greater the costsharing, the worse the medication adherence. The evidence is limited regarding the impact of cost-sharing on clinical outcomes, HRU, and costs. Limited evidence suggests increased cost-sharing is associated with more inpatient care and less outpatient care; however, a neutral to no difference was suggested for other outcomes. Although increased cost-sharing is intended to decrease total costs, studies evaluating reducing or eliminating cost-sharing found that total costs did not rise."

As noted in an article by Keith and Colleagues, the guaranteed access to preventive services without cost-sharing "has led to documented increases in cancer screening, earlier detection and treatment of chronic health conditions, and reduced disparities, among other benefits." By eliminating out-of-pocket costs, the USPSTF's recommendations have made life-saving preventive care accessible to millions who might otherwise forgo such services due to financial concerns.

Here is another study that outlines the effect of the USPSTF cost-sharing waiver policy.

Constitutional Challenge: Kennedy v. Braidwood Management

Despite its success in expanding preventive care access, the USPSTF now faces a significant legal challenge in Kennedy v. Braidwood Management, Inc. This case, heard by the Supreme Court on April 21, 2025, questions the constitutionality of the USPSTF's role under the ACA's preventive services mandate.

The core constitutional issue revolves around the Appointments Clause of the U.S. Constitution, which governs how federal officers are appointed. Under this clause, federal officers can be categorized as either "principal officers" (who must be appointed by the President and confirmed by the Senate) or "inferior officers" (who may be appointed by the President, department heads, or courts without Senate confirmation).

The plaintiffs in Braidwood argue that USPSTF members are "principal officers" because Section 2713 of the ACA gives them the power to determine which preventive services must be covered without cost-sharing by insurers and health plans. Since these members are not appointed by the President or confirmed by the Senate, the plaintiffs contend their appointments violate the Constitution's Appointments Clause.

This case has a complex history. Initially filed in 2020 as Kelley v. Azar, the litigation has spanned three presidential administrations and has been defended by both Trump administrations and the Biden administration. In 2022, Judge Reed O'Connor of the U.S. District Court for the Northern District of Texas ruled partially in favor of the plaintiffs, finding that the requirement to cover Task Force-recommended services violates the Appointments Clause. The Fifth Circuit Court of Appeals affirmed this ruling but limited its scope to the plaintiffs in the case.

During the Supreme Court oral arguments, several key issues emerged:

1. Secretary's Control Over the Task Force: A central question is whether the Secretary of Health and Human Services has sufficient control over USPSTF members and recommendations to classify them as inferior officers. The government argued that the Secretary has significant "back-end" control through his authority to remove Task Force members, prevent recommendations from taking effect, and require pre-approval before recommendations are issued.

2. Task Force Independence: The Task Force's statutory independence from political pressure is a contentious point. Section 299b-4(a)(6) of the Public Health Service Act specifies that Task Force members and recommendations are "independent and, to the extent practicable, not subject to political pressure." The plaintiffs argued this independence gives Task Force members "unreviewable discretion," while the government contended it simply requires members to exercise their best scientific judgment while remaining under the Secretary's ultimate authority.

3. Appointment Authority: Questions arose about whether Task Force members were validly appointed. Historically, Task Force members have been appointed by the director of the Agency for Healthcare Research and Quality (AHRQ), but in June 2023, HHS Secretary Xavier Becerra reappointed Task Force members both retrospectively and prospectively.

Potential Outcomes and Implications

The Supreme Court's decision, expected in summer 2025, could have far-reaching consequences for preventive healthcare in America. Several potential outcomes exist:

1. Victory for the Government: If the Court upholds Section 2713 and the Task Force's constitutionality, guaranteed coverage of USPSTF-recommended preventive services would continue. However, this would also affirm the Secretary's control over the Task Force, potentially allowing future administrations to influence its recommendations based on political rather than scientific considerations. This is of particular concern given the current administration’s politicization of health and science.

2. Victory for the Plaintiffs: If the Court finds Section 2713(a)(1) unconstitutional, millions of Americans could lose guaranteed access to preventive services without cost-sharing. While some insurers and employers might continue offering these benefits voluntarily, coverage and costs would vary significantly across plans, as they did before the ACA. So, your mammogram, your annual wellness visit, and your flu vaccine may require a co-pay, be subject to deductibles, or otherwise require out-of-pocket spending.

3. Remand on Appointment Issue: The Court might determine that Task Force members are inferior officers but remand the case to lower courts to further analyze whether they were validly appointed. This would extend the litigation but likely preserve the preventive services requirement in the interim.

4. Injunction Against Past Recommendations: The Court could find that current Task Force appointments are constitutional but issue an injunction against enforcing recommendations made between 2010 and 2023 when appointments might have been constitutionally defective. This would require the Task Force to reissue those recommendations, creating an opportunity for current administration officials to "revisit, amend, or eliminate recommendations."

The Fundamental Tension: Independence vs. Accountability

At its core, Kennedy v. Braidwood Management highlights a fundamental tension in how we structure evidence-based health care policy. The USPSTF was intentionally designed to be independent from political influences, ensuring that its recommendations reflect scientific evidence rather than political expediency. This independence is critical for maintaining the integrity and credibility of preventive care guidelines. Other countries have a much stronger system to scientifically evaluate and cover certain services, such as with NICE in the United Kingdom.

However, in a democratic system, government actions that affect millions of Americans typically require accountability to elected officials. When USPSTF recommendations were merely clinical guidance, their independence posed few constitutional concerns. But once the ACA transformed these recommendations into insurance coverage mandates, questions of democratic accountability became more pressing.

The case forces us to confront difficult questions: How do we balance the need for scientific independence with constitutional requirements for political accountability? In a world where basic facts and scientific evidence can become weaponized for political purposes, especially in health, how can we ensure the right solution? Can we structure expert bodies that both maintain scientific integrity and satisfy constitutional constraints? And if the USPSTF's current structure is found unconstitutional, how might we redesign it to preserve access to evidence-based preventive care? The U.S. health system already fails compared to peer countries. Will this take us back even further by reducing access to services that ultimately prevent disease?

This article content was significantly aided by this article.