On August 26, 2025, the Fifth Circuit Court of Appeals remanded Braidwood Management Inc. v. Becerra, Inc. back to the district court for further proceedings. The Fifth Circuit made this move in response to the recent Supreme Court ruling in this case.
Background
The Braidwood case concerns the ACA’s preventive care mandate. Under the ACA, insurers and group health plans offering non-grandfathered individual or group health coverage must cover certain preventive services without cost-sharing. The covered requirements include services given an “A” or “B” rating from the U.S. Preventive Services Task Force (USPSTF), vaccines recommended by the Advisory Committee on Immunization Practices (ACIP), and preventive care and screenings for children and women recommended by the Health Resources and Services Administration (HRSA).
When the plaintiffs initiated this case, they brought five claims against the defendants, including allegations that the ACA preventive-care mandates violate the Constitution's Appointments Clause because the appointment process for members of the USPSTF, ACIP, and HRSA did not satisfy the constitutional method for appointing officers of the United States. On this issue, the court ruled that the appointment of officers of the ACIP and HRSA satisfied the constitutional requirements, but the appointment of USPSTF officers did not. We covered the district court’s ruling in our October 11, 2022, article.
As a result, the district court issued a judgment that invalidated and prohibited the DOL, IRS, and HHS (the departments) from enforcing all USPSTF-recommended preventive care mandates issued since the ACA's March 23, 2010, enactment on a nationwide basis. Additionally, the final judgment prevents the departments from enforcing the PrEP coverage requirements for the plaintiffs with religious objections. We covered the consequences of this judgment in our April 3, 2023, article.
When the Fifth Circuit took up the case the first time, they agreed with the district court that the members of the USPSTF were not validly appointed as required by Article II of the Constitution and that the federal government had not cured this deficiency. However, the appellate court also determined that the district court overreached by enjoining all government action taken to enforce the preventive care mandate because it lacked the statutory authority to do so. Similarly, the Fifth Circuit found that the district court lacked the authority to vacate all previous decisions made by the USPSTF. Instead, the Fifth Circuit limited the injunction by preventing the government from enforcing the mandate against the plaintiffs in the case.
The Fifth Circuit also remanded the case back to the district court to consider the fate of two other government entities involved in determining what must be covered under the preventive care mandate. Although the district court and the Fifth Circuit found that the members of the ACIP and the HRSA were properly appointed, the Fifth Circuit questioned whether the process that these entities followed when making their recommendations complied with requirements under the federal Administrative Procedures Act (APA) and therefore remanded the matter back to the district court for further consideration. We covered this in our July 2, 2024, article.
The government appealed this decision to the Supreme Court, which issued its opinion on June 27, 2025. The Court reversed the Fifth Circuit ruling and held that the USPSTF members were inferior officers who were appointed in accordance with the Constitution. The Court then remanded the matter back to the Fifth Circuit for further proceedings. We covered this opinion in our July 1, 2025, article.
Now the Fifth Circuit has kicked the can back to the district court. Although the Supreme Court decided on the issue of USPSTF, the Fifth Circuit points out that the question of whether the process that the ACIP and the HRSA followed when making their recommendations complied with requirements under the federal Administrative Procedures Act (APA) has not yet been answered. Accordingly, the Fifth Circuit has sent the matter back to the district court.
Employer Takeaway
The courts are not yet done with the ACA’s preventive care mandate. Although it appears that the recommendations made by the USPSTF are on solid legal ground, other preventive care recommendations made by ACIP and the HRSA are still in question. In the meantime, the ACA preventive care mandate is still in effect and health plans must continue to comply with its requirements. Employers should be aware of the latest developments in the ongoing Braidwood litigation. We will report relevant updates in Compliance Corner.
Read the remand on the case: Braidwood Management Inc. v. Becerra, Inc.