Braidwood Management Inc. v. Becerra

The Affordable Care Act (ACA) requires most insurance plans to cover certain preventive services without imposing cost-sharing, such as a copayment or deductible. Among the services subject to the cost-free coverage requirement are preventive-care measures that have been recommended by the U.S. Preventive Services Task Force, a body of volunteer experts. These measures include screenings that enable early detection and treatment of cancer and other life-threatening diseases, prenatal care measures that support healthy pregnancies, and medications that dramatically reduce the risk of contracting and transmitting HIV.

A group of individuals and businesses opposed to the ACA filed a lawsuit against the government in federal court in Texas, arguing among other things that the ACA’s incorporation of the Task Force’s recommendations was unconstitutional. Because these recommendations created legal duties under the ACA, the plaintiffs argued, the Task Force’s members were “officers of the United States” and so had to be either nominated by the President and confirmed by the Senate (which they had not been) or answerable to a constitutionally appointed officer (which, the plaintiffs argued, they were not). The district court agreed with the plaintiffs and held the ACA’s coverage requirement unconstitutional. Rather than remedying this supposed defect by allowing the Secretary of Health and Human Services—a constitutionally appointed officer—to ratify or override Task Force recommendations, the court eliminated the cost-free coverage requirement altogether for all services that received Task Force recommendations after the ACA’s March 23, 2010, enactment.

Public Citizen filed an amicus brief on appeal on behalf of itself and seven other nonprofit public-health organizations in support of the government’s motion asking the Court of Appeals to stay the district court’s ruling while the case is on appeal. The brief emphasized that millions of Americans depend on the ACA’s guarantee of cost-free access to preventive care and argued that allowing the district court’s ruling to remain in effect during the appeal would cause irreparable harm to public health. The brief also explained that a vast body of research shows both that the preventive services subject to the district court’s ruling are effective in reducing serious illness and death and that even modest cost barriers decrease uptake of these services, particularly among economically vulnerable communities. As against the harms that would flow from the district court’s ruling, we argued, staying the ruling pending appeal would inflict no harm on either the plaintiffs or the public at large.

At the court’s urging, the parties stipulated to a stay putting the district court’s ruling on hold with respect to everyone other than the six plaintiffs. The court entered the stay on June 13, leaving the ACA’s requirements – including cost-free coverage of preventive care in accordance with the Task Force’s recommendations – in place during the duration of the appeal.

In June 2023, on behalf of Public Citizen, American Lung Association, AcademyHealth, Adult Vaccine Access Coalition, American Heart Association, Campaign for Tobacco-Free Kids, Families USA, GO2 for Lung Cancer, LUNGevity Foundation, Parents Against Vaping E-Cigarettes, Public Health Law Center, and Truth Initiative Foundation, we filed an amicus brief on the merits. The brief explained that, for 40 years, the Task Force has made expert recommendations to the medical community about which preventive-care measures have been reliably shown to promote patient health, that Congress’s decision to incorporate these recommendation into the ACA does not violate the Appointments Clause, and that, even given the district court’s erroneous ruling that Congress’s decision to incorporate these recommendations into the ACA violated the Appointments Clause, the district court ordered an overbroad remedy that, if upheld, would threaten access to vital healthcare for millions of Americans.

In June 2024, the Fifth Circuit issued a decision holding that the ACA’s incorporation of the Task Force’s recommendations violated the Appointments Clause. As to remedy, the court held that the district court erred in barring the government from enforcing the ACA’s cost-free coverage mandate entirely and that the government was barred from enforcing the mandate only against the plaintiffs who filed the lawsuit.

The U.S. Supreme Court then granted review. On behalf of 11 organizations (Public Citizen, AcademyHealth, AIDS Healthcare Foundation, American Heart Association, American Lung Association, Campaign for Tobacco-Free Kids, Families USA, GO2 for Lung Cancer, Parents Against Vaping E-Cigarettes, Public Health Law Center, and Truth Initiative Foundation), we then filed an amicus brief explaining that the Patient Protection and Affordable Care Act provisions that guarantee patients’ access to cost-free coverage for preventive-care measures recommended by the U.S. Preventive Services Task Force are both lawful and critically important for public health.