最高法院以6比3维持医保预防服务免费覆盖制度、工作组任命合宪
2025年6月27日，美国最高法院在华盛顿以6比3推翻联邦第五巡回上诉法院的裁决，认定美国预防服务工作组成员由卫生与公众服务部部长任命符合宪法第二条的任命条款。这意味着《平价医疗法案》要求保险计划免费覆盖工作组推荐的预防服务的制度继续有效。
预防服务工作组是卫生与公众服务部内的一个机构，由16名成员组成，就癌症、糖尿病筛查等预防保健服务发布循证建议。它给40多项服务评了最高的 A 级或 B 级，包括肺癌、乳腺癌、宫颈癌和结直肠癌筛查、降低乳腺癌风险的药物、帮助成年人戒烟的尼古丁贴片、降低心脏病和中风风险的他汀类药物、帮助老年人防跌倒的物理治疗，以及糖尿病筛查。2010年之前，工作组的建议只是咨询性质；《平价医疗法案》生效后，多数保险计划必须覆盖 A 级或 B 级服务，且不得向投保人收取自付额、共付额等任何费用分担。
案件由多名个人和 Braidwood Management 等小企业在德克萨斯州北区联邦地区法院提起。原告反对预防服务覆盖要求，其中包括对覆盖预防艾滋病病毒感染的暴露前预防药物的宗教异议。地区法院和第五巡回上诉法院先后认定，工作组成员属于必须由总统提名、经参议院确认的主要官员，由部长任命违宪。诉讼期间，卫生与公众服务部部长于2023年追认了现有成员的任命，并在此后继续直接任命成员。
大法官 Brett Kavanaugh 撰写的多数意见说，判断关键在于工作组成员是主要官员还是下级官员。工作组成员可由部长随时免职，其建议在生效前可由部长审查，部长可以阻止建议生效，因此成员受部长的指导和监督，而部长本人对总统负责，宪法第二条的指挥链条完整保留。多数意见据此认定，工作组成员是下级官员，由部门首长任命合宪。首席大法官 John Roberts 与大法官 Sonia Sotomayor、Elena Kagan、Amy Coney Barrett、Ketanji Brown Jackson 加入多数意见。
大法官 Clarence Thomas 的异议意见认为，国会没有明确把工作组成员的任命权授予卫生与公众服务部部长，按任命条款的默认规则，这类官员应由总统提名、经参议院同意任命。大法官 Samuel Alito 与 Neil Gorsuch 加入异议。
裁决的直接效果是，保险计划免费覆盖预防服务的现行要求不变，工作组可以继续发布决定覆盖范围的建议。多数意见同时确认，部长对工作组成员握有随时免职权，并能在建议生效前审查和阻断建议。案件编号为第24-316号。
（来源：美国最高法院）
Supreme Court Upholds ACA Preventive Services Coverage, 6-3, Ruling Task Force Appointments Constitutional
On June 27, 2025, the Supreme Court in Washington ruled 6-3 to reverse the Fifth Circuit and held that appointment of the members of the U.S. Preventive Services Task Force by the Secretary of Health and Human Services is consistent with the Appointments Clause of Article II. The ruling leaves in place the Affordable Care Act requirement that health insurers cover preventive services recommended by the Task Force at no cost to the insured.
The Task Force, an entity within the Department of Health and Human Services, consists of 16 members who issue evidence-based recommendations on preventive health care services such as cancer and diabetes screenings. It has given an A or B rating to more than 40 services, including screenings for lung, breast, cervical, and colorectal cancer, risk-reducing medications for women at high risk of breast cancer, nicotine patches for adults trying to quit smoking, statin medications to reduce the risk of heart disease and stroke, physical therapy to help the elderly avoid falls, and diabetes screenings. Before 2010 the recommendations were purely advisory; under the Affordable Care Act, most health plans must cover A- or B-rated services without copayments, deductibles, or other cost sharing.
Several individuals and small businesses, led by Braidwood Management, sued in the U.S. District Court for the Northern District of Texas, objecting to the preventive-services coverage requirements, including a religious objection to covering pre-exposure prophylaxis drugs that prevent HIV infection. The district court and the Fifth Circuit held that Task Force members are principal officers who must be nominated by the President and confirmed by the Senate. In June 2023, while the appeal was pending, the Secretary ratified the appointments of the existing members and has appointed members directly since then.
In the majority opinion, Justice Brett Kavanaugh wrote that the question turned on whether Task Force members are principal or inferior officers. Task Force members are removable at will by the Secretary, and their recommendations are reviewable by the Secretary, who can block them before they take effect, so members are supervised and directed by the Secretary, who in turn answers to the President. The Court therefore held that the members are inferior officers whose appointment by the head of a department is constitutional. Chief Justice John Roberts and Justices Sonia Sotomayor, Elena Kagan, Amy Coney Barrett, and Ketanji Brown Jackson joined the majority.
Justice Clarence Thomas dissented, arguing that Congress had not explicitly vested appointment authority over the Task Force in the Secretary and that, under the Appointments Clause’s default rule, such officers must be appointed by the President with the advice and consent of the Senate. Justices Samuel Alito and Neil Gorsuch joined the dissent.
The immediate effect of the decision is that the existing no-cost preventive services coverage requirement remains unchanged and the Task Force can continue issuing the recommendations that drive coverage. The majority also confirmed that the Secretary may remove Task Force members at will and may review and block their recommendations before they take effect. The case is No. 24-316.
(Source: Supreme Court of the United States)
来源：美国最高法院
发布：GSM·美国（发布链接）
图片来源：图：位于华盛顿的美国卫生与公众服务部总部 Hubert H. Humphrey Building 入口标识，本案焦点预防服务工作组设在该部之内。Lorax 摄，CC BY 4.0，经 Wikimedia Commons。 / Photo: Entrance sign of the Hubert H. Humphrey Building in Washington, headquarters of the U.S. Department of Health and Human Services, the department that houses the Preventive Services Task Force at issue. Photo by Lorax, CC BY 4.0, via Wikimedia Commons.
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