Constitutional Law: Legal Analysis of Kennedy v. Braidwood (2025)

Written by Rowen Hamilton, Munpreet Kaur, Isabela Casimiro, Sofia Fennell, Cole Frey

Edited by Rowen Hamilton and Anna Ramesh

Background and Overview

When Congress passed the Affordable Care Act in 2010, the Act required private insurers to cover recommended preventive-care services without imposing additional costs upon the insured. However, the Affordable Care Act did not define these recommended services. To keep the recommendations relevant, federal agents seek advice through three agencies under the Department of Health and Human Services: the United States Preventive Services Task Force, Advisory Committee on Immunization Practices (ACIP), and the Health Resources and Services Administration (HRSA). All of these agencies were made up of volunteer-experts in their respective fields that were appointed for four-year terms and they were appointed by the Secretary of Health and Human Services.

The United States Preventive Services Task Force issued a recommendation for PrEP—a medication for HIV—in 2019. The plaintiffs, composed of four private individuals and two businesses with Christian values, took issue with the recommendation and argued that making PrEP mandatory coverage under their private insurance was a violation of their religious beliefs against affirming homosexuality.

The plaintiffs filed in 2020 against the federal government. They claimed these agencies had violated the Appointments Clause of the Constitution. The HHS Secretary appointed these positions, but Secretaries are only allowed to appoint inferior officers. The plaintiffs argue that these positions are not inferior and are thus not appointable by the Secretary alone, instead requiring the advice and consent of the Senate. The initial decision by the district court supported the plaintiff's argument against the Task Force. However, the court did not agree in extending challenges against ACIP and HRSA, so the plaintiffs appealed their decision. Once it moved up to the U.S. Court of Appeals for the Fifth Circuit, the Court affirmed that the Task Force violated the Appointments Clause by virtue of its structure. The Court agreed not to extend the challenges against the ACIP and HRSA, but it reversed the lower court's decision regarding further consideration on if the Health and Human Services had properly ratified ACIP and HRSA's recommendations. After being appealed to the Supreme Court, the appointments were deemed constitutional under the Appointments Clause.

Precedent

United States v. Hartwell (1867) - Erskine Hartwell was hired as a clerk within the Office of the Assistant Treasurer and was charged with embezzling government funds. However, he wasn't officially appointed. Being an officer would make Hartwell liable to federal criminal statutes about the misuse of public funds, so the question at hand was whether he qualified as an officer of the United States. The Supreme Court held that he was an officer because his position was established by law, had continuing duties, and involved the exercise of significant public responsibility—not just temporary or occasional tasks. Although he was not appointed by the Senate, This case clarified a basic quality of an inferior officer: They are appointed directly by a Department secretary/supervisor. Although both superior and inferior officers are still accountable to federal law, inferior officers do not need to be approved through the Appointments Clause in the Constitution.

United States v. Germaine (1879) - Dr. James Germaine—a civil surgeon appointed by the Commissioner of Pensions—was accused of misconduct. However, he argued his removal was invalid because he had not been properly appointed by the President and confirmed by the Senate. The Supreme Court found that Germaine was not a superior officer that required nomination and approval. Instead, he was merely an employee and extension of the Department Secretary. This case formally created the distinction between inferior officers and superior officers. The Supreme Court recognized that subjecting all federal officers to the constitutional appointment process would be wildly impractical and difficult. This means that secretaries—as heads of departments—are given some prerogative to appoint their own staff while not being vested with appointment power.

Edmond v. United States (1997) - Civilian judges on the Coast Guard Court of Criminal Appeals were appointed by the Secretary of Transportation rather than by the President with Senate confirmation. Edmond—a Coast Guard member whose conviction by court marshal was reviewed by the Coast Guard Court of Appeals—argued that the court appointees were unconstitutional. The Supreme Court held that these judges were inferior officers because their work was supervised by higher executive officials like the Judge Advocate General and the Court of Appeals for the Armed Forces. This case clarified that the operational power of an inferior officer is enabled by or accountable to a Department Secretary. An inferior officer's powers can be reviewed, approved, or rejected by a Secretary's statutory authority even if this authority does not actively influence their procedures (in other words, even if an agency or agent is deemed independent by statutory language). The chain of authority from inferior officer to Secretary to President is preserved, and the President's selection of Secretary is still held accountable to the Appointments Clause.

United States v. Arthrex, Inc. (2021) - Arthrex—a medical device company—lost a patent dispute in front of the Patent Trial Appeal Board (PTAB). As a result, Anthrex argued that the Administrative Patent Judges (AJPs) had not been properly appointed through the Appointments Clause. The Supreme Court found that because APJs had exercised too much power to be considered inferior officers. To fix the problem, the Court ruled that the Director of the U.S. Patent and Trademark Office must have the power to review/reverse PTAB decisions, making the APJs constitutionally valid as inferior officers under the new structure. Although this case isPatent judges, although nominated by Executive agents, could not be removed by the Executive's discretion. They have to be removed for cause—or for some reason related to malpractice. However, patent judges were deemed deemed inferior officers by the Supreme Court because they were subject to review authority, so Task Force members—subject to both at-will removal and review authority—must also be inferior officers.

Effects of Kennedy v. Braidwood

The Court's decision in Kennedy v. Braidwood (2025) kept the Affordable Care Act's preventive care requirement in place and confirmed that the U.S. Preventative Services Task Force operated constitutionally under the Department of Health and Human Services. The Court ruled that Task Force members are considered inferior officers who can be appointed by the Secretary of Health and Human Services. The agency's recommendations like covering PrEP, vaccines, and cancer screenings remain valid. This decision made it easier for patients to access certain preventative care services without having to pay extra costs. It preserved the ACA's ability to issue recommendations but gave more control to the HHS Secretary. Overall, this case supported the ACA's structure but showed how complicated it can be to balance healthcare policy, religious beliefs, and government power.

This decision was seen as a major win for healthcare advocates who feared a rollback of preventative care benefits under the Trump administration. In spite of that, the Court's ruling strengthened the Executive's ability to reshape healthcare access through strategic appointments. Following the Court's ruling, the Secretary of Health and Human Services fired all 17 members of the Advisory Committee on Immunization Practices (ACIP) and appointed eight new committee members that have begun re-evaluating the entire childhood vaccine schedule. Kennedy v. Braidwood (2025) effectively reinforced the idea that while judicial decisions can help protect healthcare laws, administrative discretion ultimately has a more significant and lasting impact on the care Americans receive.

Terms and Definitions

Agency for Healthcare Research and Quality (AHRQ). A research arm of the U.S. Department of Health and Human Services that provides evidence-based information to improve healthcare through patient safety, quality of care, and health equity.

Affordable Care Act. Healthcare legislation passed in 2010 that required insurers to cover—among other types of healthcare—preventative care. This legislation gave the Task Force the indirect power to determine what services that insurers would be required to finance based on the agency's rankings.

Appointments Clause. A provision within Article II of the Constitution, allows the President to nominate/appoint certain public officials with the advice and consent of the Senate.

U. S. Preventive Services Task Force. An independent volunteer panel of medical experts that provides recommendations to improve public health and evaluates scientific research to guide preventive clinical services.