logo
The Supreme Court case that seeks to make everyone's health insurance worse, explained

The Supreme Court case that seeks to make everyone's health insurance worse, explained

Vox14-04-2025

is a senior correspondent at Vox, where he focuses on the Supreme Court, the Constitution, and the decline of liberal democracy in the United States. He received a JD from Duke University and is the author of two books on the Supreme Court.
If you paid any attention at all to US politics in the 2010s, you'll remember the seemingly endless stream of lawsuits seeking to undermine, or even repeal altogether, the Affordable Care Act. Turns out, these suits never ended.
On April 21, the Supreme Court will hear Kennedy v. Braidwood Management, the latest attempt to convince a judiciary dominated by Republicans to sabotage President Barack Obama's signature legislative achievement.
SCOTUS, Explained
Get the latest developments on the US Supreme Court from senior correspondent Ian Millhiser. Email (required)
Sign Up
By submitting your email, you agree to our Terms and Privacy Notice . This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
Unlike some of these earlier lawsuits, Braidwood is not an existential threat to the entire law. Currently, Obamacare gives the Department of Health and Human Services, acting through an institution known as the US Preventive Services Task Force (PSTF), broad authority to require health insurers to cover a wide range of preventative health treatments — from cancer screenings, to medications that prevent the transmission of HIV, to eye ointments that prevent blindness-causing infections in infants.
The plaintiffs in this case, who are represented by former Trump lawyer and anti-abortion crusader Jonathan Mitchell, essentially seek to strip HHS of this authority, thus allowing insurers to deny care for a wide range of treatments they are required to cover by law.
As is often the case in these anti-Obamacare lawsuits, Mitchell essentially argues that the Affordable Care Act and some other relevant health laws should be read to render them — and the PSTF — unconstitutional, and asks the Court to conclude that his reading is the only way to interpret the statute. The government offers a much more plausible interpretation of these laws in its brief.
There are multiple reasons to reject Mitchell's approach. One is that the Supreme Court has long applied a doctrine, known as 'constitutional avoidance,' which says that when a statute is open to multiple interpretations, the Court should avoid choosing one that would render it unconstitutional.
Additionally, in King v. Burwell (2015), the Court specifically warned against reading Obamacare in ways that undermine the law's goals. In that case, the plaintiffs identified a poorly drafted provision of the law which, if read out of context, seemed to create a regime that would have collapsed the individual health insurance markets in most states. But the Court rejected this interpretation, concluding instead that 'Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them,' and so the Court must try to 'interpret the Act in a way that is consistent with the former, and avoids the latter.'
Still, the Court's membership has changed considerably since King. Justices Anthony Kennedy and Ruth Bader Ginsburg, both members of the King majority, were replaced by Trump justices, and King was only a 6-3 decision. So it is far from clear whether the current Court will have the same compunctions about reading federal law to defeat Obamacare.
What's the legal issue in Braidwood?
Braidwood turns on a provision of the Constitution concerning the federal government's hiring practices for officials known as 'officers of the United States.' The highest-ranking officials, who are commonly referred to as 'principal officers,' must be nominated by the president and confirmed by the Senate. A lower tier of officials, known as 'inferior officers,' may be appointed by the president, by a federal court, or by 'the heads of departments' — meaning that they do not necessarily require Senate confirmation.
Although the Constitution does not define the terms 'principal officer' and 'inferior officer,' the Supreme Court has fleshed out these two concepts considerably in its decisions. In United States v. Arthrex (2021), for example, the Court suggested that 'only an officer properly appointed to a principal office may issue a final decision binding the Executive Branch.' So, if someone makes final, binding decisions that cannot be reviewed by a higher ranking official, they generally must be confirmed by the Senate.
Inferior officers, meanwhile, may still wield considerable influence and authority — so long as their work is overseen by a higher-ranking official. This is true, even if that officer's superiors typically do not exercise their power to overrule an inferior officer. As the Court said in Edmond v. United States (1997), ''inferior officers' are officers whose work is directed and supervised at some level by others who were appointed by Presidential nomination with the advice and consent of the Senate.'
The PSTF is a panel of medical and public health experts appointed by the secretary of Health and Human Services, so their appointments are valid if they count as inferior officers but not if they count as principal officers. Since Obamacare took full effect, the PSTF has typically decided which preventive medical treatments health insurers must cover. The dispute in Braidwood hinges upon whether the health secretary exercises enough supervision over this panel to comply with the constitutional requirement that inferior officers must have a superior who is a principal officer.
Related The Supreme Court shut down an attack on Obamacare in the most dismissive way possible
According to the Justice Department's brief in Braidwood, the case for upholding the PSTF's authority is straightforward. The Court has historically looked at two factors to determine whether an inferior officer is properly supervised — whether they can be removed by a principal officer, and whether a principal officer can review their decisions.
The answer to the first question is pretty clear cut. Thus far, four judges have heard the Braidwood case, and they include some of the most anti-Obamacare voices within the judiciary. All of them concluded that the secretary may remove PSTF members at will.
The answer to the second question is marginally less clear, but the Justice Department still makes a very strong argument that PSTF members are supervised by principal officers. The PSTF sits within the Public Health Service, and a federal law provides that this service 'shall be administered by the Assistant Secretary for Health under the supervision and direction of the Secretary.' Both the assistant secretary and the secretary are Senate-confirmed officials, so this statute establishes that the entire Public Health Service is controlled by a principal officer. And it is one of several statutes the government cites, which give the secretary broad control over institutions within the PSTF.
Additionally, after the PSTF determines that a particular medical treatment should be covered by insurers, a different federal law instructs the secretary to determine when that new coverage requirement should take effect — with an additional requirement that implementation of the PSTF's conclusion must be delayed by at least one year. So, even if the health secretary didn't have broad control over the entire Public Health Service, he still has the authority to delay any decision made by the PSTF indefinitely — and then to use that period of delay to remove the members of the PSTF and replace them with new officials who reject their predecessors' decision.
PSTF members, in other words, serve at the pleasure of a principal officer, and cannot actually do anything over that officer's objections. So, under the Court's precedents, they sure look like validly appointed inferior officers.
So what's the case against the PSTF?
Mitchell's case against the PSTF largely consists of finding statutes that can conceivably be read to render this body unconstitutional, and then insisting that they must be read that way. His brief, for example, places a simply enormous amount of weight on a provision of federal law which states that PSTF members 'shall be independent and, to the extent practicable, not subject to political pressure.'
Read in isolation, it's certainly possible to construe this statute to grant PSTF members complete and total independence from any other public official. But that's hardly the only permissible reading of this law. Among other things, the fact that it only frees the PSTF from political pressure 'to the extent practicable' is a problem for Mitchell. If insulating the PSTF from secretarial control renders it unconstitutional, then it is not 'practicable' to do so.
The Justice Department, meanwhile, offers an equally plausible alternative reading of this provision. It says that it requires the PSTF members themselves to 'make recommendations based on their impartial medical and public-health judgments,' but the fact that these recommendations are themselves rooted in independent judgment does not mean that the secretary must give legal effect to the PSTF's decisions.
Under the principle of constitutional avoidance, the justices should prefer the DOJ's construction of the statute over Mitchell's, because courts should reject the unconstitutional option when faced with two plausible ways to read a law.
Similarly, Mitchell argues elsewhere in his brief that a law permitting the secretary and assistant secretary to 'administer' the PSTF is not broad enough to allow them to supervise its work, but that argument boils down to nothing more than a rehash of his other argument. According to Mitchell, 'the responsibility to 'administer' does not empower the Assistant Secretary for Health or his commanding officers to direct and supervise a Task Force that the law requires to be 'independent' and free from 'political pressure.''
There's also one other reason to question whether Mitchell's arguments have any real force. Typically, when the Supreme Court determines that a federal body is unconstitutional because of a problem with how its members are appointed or supervised, it tries to preserve that body by striking down the specific legal provision that creates a constitutional problem, while also leaving the rest of the law intact.
In Free Enterprise Fund v. Public Company Accounting Board (2010), for example, the Supreme Court determined that a five-member government board that regulates accounting firms was not adequately supervised by a principal officer because its members could not be fired at will. Rather than strike down the entire board, however, the Court merely stripped its members of their protections from being fired, and placed the board under the full supervision of Senate-confirmed officials in the Securities and Exchange Commission.

Orange background

Try Our AI Features

Explore what Daily8 AI can do for you:

Comments

No comments yet...

Related Articles

The ACLU demands the US release and return a Dominican woman living legally in Puerto Rico

time7 minutes ago

The ACLU demands the US release and return a Dominican woman living legally in Puerto Rico

SAN JUAN, Puerto Rico -- In late May, a 47-year-old woman from the Dominican Republic was detained by police in Puerto Rico after she entered a municipal building seeking a permit to sell ice cream on the beach to support herself. Upon being turned over to federal agents, the Dominican woman presented her passport, driver's license and work permits that proved she was living in the U.S. territory legally, her attorney Ángel Robles and the American Civil Liberties Union of Puerto Rico, said Monday. Despite the documents presented, authorities recently transferred her to Texas as part of a federal crackdown on migrants living illegally in U.S. jurisdictions. The woman, whose first name is Aracelis, has not been fully identified because she is a victim of domestic violence. Aracelis is among hundreds of people who have been detained in Puerto Rico since large-scale arrests began in late January, surprising many in the U.S. territory that has long welcomed migrants. Robles and the ACLU demanded Aracelis' release and return to Puerto Rico. 'It's outrageous,' Robles said in a phone interview. 'No charges have been filed against her, and she is not in the system.' Because her name does not appear in a federal database, Robles' request for a bond hearing was denied. 'This case is one of unspeakable abuse,' said Annette Martínez Orabona, the ACLU director in Puerto Rico. The case has fueled already simmering anger against the administration of Puerto Rico Gov. Jenniffer González Colón and local authorities who have been working with U.S. Immigration and Customs Enforcement agents to arrest those believed to be living illegally in the U.S. territory. In a letter sent Monday to the governor and the island's justice secretary, the ACLU accused Puerto Rico's government of violating the Constitution and local laws by providing ICE and U.S. Homeland Security with confidential information on nearly 6,000 immigrants. It also accused ICE of using that data to go on a 'fishing expedition' that it called 'arbitrary and abusive.' A spokesman for Homeland Security Investigations did not immediately respond to a request for comment. In Puerto Rico, undocumented immigrants are allowed to open bank accounts and obtain a special driver's license. The ACLU in Puerto Rico also accused González Colón's administration of not providing protocols to local government agencies for how to deal with such requests from the federal government. The ACLU requested, among other things, that Puerto Rico's government issue an executive order barring public agencies from collaborating with ICE subpoenas not accompanied by a court order. A spokeswoman for the governor did not immediately return a message for comment.

Minnesota budget deal cuts health care for adults who entered the US illegally

time27 minutes ago

Minnesota budget deal cuts health care for adults who entered the US illegally

ST. PAUL, Minn. -- Adults living in the U.S. illegally will be excluded from a state-run health care program under an overall budget deal that the closely divided Minnesota Legislature convened to pass in a special session Monday. Repealing a 2023 state law that made those immigrants eligible for the MinnesotaCare program for the working poor was a priority for Republicans in the negotiations that produced the budget agreement. The Legislature is split 101-100, with the House tied and Democrats holding just a one-seat majority in the Senate, and the health care compromise was a bitter pill for Democrats to accept. The change is expected to affect about 17,000 residents. After an emotional near four-hour debate, the House aroved the bill 68-65. Under the agreement, the top House Democratic leader, Melissa Hortman, of Brooklyn Park, was the only member of her caucus to vote yes. The bill then went to the Senate, where it passed 37-30. Democratic Majority Leader Erin Murphy, of St. Paul, called it 'a wound on the soul of Minnesota,' but kept her promise to vote yes as part of the deal, calling it "among the most painful votes I've ever taken." Democratic Gov. Tim Walz, who insisted on maintaining eligibility for children who aren't in the country legally, has promised to sign the legislation, and all 13 other bills scheduled for action in the special session, to complete a $66 billion, two-year budget that will take effect July 1. 'This is 100% about the GOP campaign against immigrants,' said House Democratic Floor Leader Jamie Long, of Minneapolis, who voted no. 'From Trump's renewed travel ban announced this week, to his effort to expel those with protected status, to harassing students here to study, to disproportionate military and law enforcement responses that we've seen from Minneapolis to L.A., this all comes back to attacking immigrants and the name of dividing us.' But GOP Rep. Jeff Backer, of Browns Valley, the lead author of the bill, said taxpayers shouldn't have to subsidize health care for people who aren't in the country legally. Backer said California Gov. Gavin Newsom, a Democrat, has proposed freezing enrollment for immigrants without legal status in a similar state-funded program and that Illinois' Democratic governor, JB Pritzker, has proposed cutting a similar program. He said residents can still buy health insurance on the private market regardless of their immigration status. 'This is about being fiscally responsible,' Backer said. Enrollment by people who entered the country illegally in MinnesotaCare has run triple the initial projections, which Republicans said could have pushed the costs over $600 million over the next four years. Critics said the change won't save any money because those affected will forego preventive care and need much more expensive care later. 'People don't suddenly stop getting sick when they don't have insurance, but they do put off seeking care until a condition gets bad enough to require a visit to the emergency room, increasing overall health care costs for everyone,' Bernie Burnham, president of the Minnesota AFL-CIO, told reporters at a news conference organized by the critics. Walz and legislative leaders agreed on the broad framework for the budget over four weeks ago, contrasting the bipartisan cooperation that produced it with the deep divisions at the federal level in Washington. But with the tie in the House and the razor-thin Senate Democratic majority, few major policy initiatives got off the ground before the regular session ended May 19. Leaders announced Friday that the details were settled and that they had enough votes to pass everything in the budget package.

Planning to vote in New Jersey's June 10 primary? This is what you need to know
Planning to vote in New Jersey's June 10 primary? This is what you need to know

Yahoo

timean hour ago

  • Yahoo

Planning to vote in New Jersey's June 10 primary? This is what you need to know

The New Jersey primary election is under way. Voters should know their options before heading to the polls. This year's gubernatorial primary will be held June 10, and it is a packed field for the top spot on both sides of the aisle. There are 11 candidates in all — six Democrats and five Republicans. They are vying to represent their respective party in the race for governor this November. There are also contested local primary elections and some contested races for seats in the New Jersey Assembly, the lower house of the Legislature. It's also the first primary to be held without the county line ballot design, so voters will be able to familiarize themselves with the new design with the sample ballots they're set to receive by mail in the coming days. The block ballot design, which is used in all 49 other states, will replace the county line which traditionally gave candidates endorsed by the county party preferred ballot placement, and an edge in their efforts. It was dismantled by a federal judge last year. New Jersey has what's considered a semi-closed primary because all voters have to declare a party affiliation to participate, but unaffiliated voters can do so at the polls. Unaffiliated voters can register while voting in personon Election Day for either the Democratic Party or the Republican Party. After an unaffiliated voter casts an in-person vote in the Democratic or Republican Party primary election, the voter will be affiliated with that political party going forward. The voter can change affiliation by completing, signing and returning a change of party affiliation form to the municipal clerk or county commissioner of registration. The deadline to apply for a mail-in ballot has passed and early in-person voting has concluded. Election Day for this year's primary will be June 10. Polls are open June 10 from 6 a.m. to 8 p.m. That is the deadline to postmark a mail-in ballot for it to be eligible. Mail-in ballots can also be delivered to County Boards of Election and authorized ballot drop boxes by 8 p.m. on June 10. Katie Sobko covers the New Jersey Statehouse. Email: sobko@ This article originally appeared on NJ primary election 2025: How to vote on June 10 date

DOWNLOAD THE APP

Get Started Now: Download the App

Ready to dive into the world of global news and events? Download our app today from your preferred app store and start exploring.
app-storeplay-store