NEJM Interviews NEJM Interview: Nicholas Bagley on the Supreme Court’s decision in a case with implications for coverage of preventive services.
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Aug 20, 2025 Nicholas Bagley, a law professor at the University of Michigan, discusses a pivotal Supreme Court ruling on preventive healthcare coverage. He dives into the implications of the ruling for the Affordable Care Act and the authority of the U.S. Preventive Services Task Force. The conversation also touches on constitutional challenges and the role of leadership in shaping future preventive services. Bagley raises concerns about politicization in healthcare, particularly regarding sexual health services, and the broader impact on patient access.
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How USPSTF Gained Binding Power
- The USPSTF began as an advisory body without formal power and later gained binding authority through the ACA.
- The ACA required insurers to cover A or B rated preventive services without cost sharing, shifting public-health incentives.
Texas Wellness Clinic Challenged PrEP Mandate
- The case was brought by plaintiffs in Texas including a wellness clinic owner who objected to PrEP coverage on religious grounds.
- The lawsuit combined religious-liberty claims with a structural Appointments Clause challenge to the PSTF's authority.
Appointments Clause Limits Who Can Exercise Power
- The Appointments Clause requires officers wielding federal power to be appointed by the president or a department head authorized by Congress.
- Bagley explains this prevents unaccountable officers from exercising coercive government authority.