Washington — The Supreme Court on Friday upheld the structure of a federal health task force that recommends preventive medical services that must be provided to patients at no cost under the Affordable Care Act.

The ruling from the Supreme Court in the case known as Kennedy v. Braidwood Management, Inc. leaves intact the 16-member U.S. Preventive Services Task Force. The task force is part of the Department of Health and Human Service and has for decades been making recommendations on preventive medical services to avoid serious health conditions.

The court ruled 6-3 in finding that the task force members are inferior officers, whose appointment by the head of Health and Human Services is consistent with the Constitution’s Appointments Clause. Justice Brett Kavanaugh authored the majority opinion, with Justices Clarence Thomas, Samuel Alito and Neil Gorsuch in dissent.

“[T]he Task Force members’ appointments are fully consistent with the Appointments Clause in Article II of the Constitution,” Kavanaugh wrote. “The structure of the Task Force and the manner of appointing its officers preserve the chain of political accountability that was central to the Framers’ design of the Appointments Clause: The Task Force members were appointed by and are supervised and directed by the Secretary of HHS. And the Secretary of HHS, in turn, answers to the president of the United States.”

The work of the task force took on added significance after passage of the Affordable Care Act in 2010. The law requires health insurers and group health plans to provide preventive services that are recommended by the task force without imposing co-pays, deductibles or other cost-sharing charges on patients.

A group of Christian-owned businesses and individuals filed a lawsuit arguing that the preventive-care coverage mandates cannot be enforced because the task force members were unconstitutionally appointed.

The plaintiffs specifically took issue with the task force’s recommendation in June 2019 that PrEP, a medication to prevent HIV, be included in the preventive services covered without cost-sharing arrangements. They argued that providing no-cost coverage of PrEP “encourages and facilitates homosexual behavior,” which conflicts with their religious beliefs, and said they want to purchase or provide plans that exclude coverage of that medication.

Among the other preventive services recommended by the task force are screenings for lung, cervical and colorectal cancers, as well as diabetes, and statin medications to reduce the risk of heart disease and stroke.

A federal district court and the U.S. Court of Appeals for the 5th Circuit found that the task force’s structure is unconstitutional under the Constitution’s Appointments Clause. The courts concluded that its members are principal officers and therefore had to be nominated by the president and confirmed by the Senate.

But the Supreme Court reversed the 5th Circuit’s ruling, finding that task force members are “inferior officers” since they are “removable at will by the Secretary of HHS, and their recommendations are reviewable by the Secretary before they take effect.”

“So Task Force members are supervised and directed by the Secretary, who in turn answers to the President, preserving the chain of command in Article II,” Kavanaugh wrote.

The dispute over the task force saw rare agreement between the Biden administration, which appealed the 5th Circuit’s decision to the Supreme Court, and the Trump administration, which continued to defend the board’s structure.

But the legal wrangling over the preventive coverage mandates also threatened to put at risk access to preventive care. Nonprofit organizations warned the Supreme Court that eliminating cost-sharing for services like breast cancer screenings or HIV-prevention medications would dissuade patients from seeking medical care.