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The Department of Health and Human Services created an advisory body known as the U. S. Preventive Services Task Force, which formulates and publishes evidence-based recommendations regarding preventive healthcare services. In 1999, Congress enacted legislation codifying the role of the Task Force as an entity within the Agency for Healthcare Research and Quality (AHRQ), which in turn is an agency in the Public Health Service within HHS. The Task Force consists of 16 members who are now appointed by the Secretary of HHS to staggered 4-year terms. Those members are “nationally recognized experts in prevention, evidence-based medicine, and primary care.” At first, the Task Force’s recommendations were purely advisory. That changed in 2010 with the passage of the Affordable Care Act. That Act requires most health insurers and group health plans to cover certain preventive services without imposing copayments, deductibles, or other charges on patients. After the Task Force makes a recommendation, the insurance coverage requirements for that preventive service do not take effect immediately. The law directs the Secretary of HHS to “establish a minimum interval,” not less than one year, when insurers must cover the recommended service without cost sharing. During that interval, the Secretary can review the Task Force’s recommendation and block it from going into effect. The Affordable Care Act also described the Task Force as “independent” and provided that the members of the Task Force and their recommendations “shall be independent and, to the extent practicable, not subject to political pressure.” Ps are several individuals and small businesses who object to the Affordable Care Act’s preventive-services coverage requirements. Ps sued and argued that the structure of the Task Force violated the Appointments Clause. Ps claimed the Task Force members are principal officers who must be appointed by the President “with the Advice and Consent of the Senate.” The District Court agreed. The court concluded that Task Force members are unconstitutionally appointed principal officers because they “have no superior” who supervises and directs them. D appealed. In June 2023, while D’s appeal was pending, the Secretary of HHS ratified the appointments of the existing Task Force members and re-appointed them on a prospective basis. And from then on, the Secretary has continued to appoint Task Force members. The Fifth Circuit held that the Task Force members are principal officers who must be appointed by the President with the advice and consent of the Senate. It concluded that the Secretary cannot block Task Force recommendations before they take effect. The court pointed to 42 U. S. C. §299b-4(a)(6), which provides that Task Force members “shall be independent and, to the extent practicable, not subject to political pressure.” The Task Force, according to the Fifth Circuit, “cannot be ‘independent’ and free from ‘political pressure’ on the one hand, and at the same time be supervised by the HHS Secretary, a political appointee, on the other.” The court concluded that the Task Force is not supervised and directed by the Secretary, and that Task Force members are therefore principal officers and may not be appointed by the Secretary. D appealed.

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