The Trump administration has signaled it may take control of a health advisory board, potentially upending four decades of precedent that has allowed the panel to operate independently.
Attorneys for the administration told the Supreme Court last Monday that Health and Human Services Secretary Robert F. Kennedy Jr. has the power to reject decisions or even fire members of the U.S. Preventive Services Task Force, a key panel at HHS that says what can count as “preventive care.” Additionally, efforts to shrink the agency have eliminated the subagency where the task force was housed, giving Kennedy a more direct line to the panel’s work.
The Department of Justice is arguing that the recommendations of the panel — which include recommending that people get services like cancer and diabetes screenings, testing for sexually transmitted infections and medication to prevent HIV — must be covered by insurance on the grounds that the HHS secretary has full authority to block those recommendations.
Panel members “have to have their independence in order to make decisions,” said a former senior HHS official during the first Trump administration. “To have a specific decision, to say yay or nay on that specific decision, I think is probably not wise.”
“Our system has been set up so that it gives, it has given, significant latitude and independence to the people making recommendations,” the former official continued. “To say that the panel ought to be making this recommendation, not based upon their best judgment, but based upon the desires of the sitting administration, whoever they are, would move it in a different direction.”
Since its inception in 1984, the task force has not been subject to any political, federal, financial, or policy pressure to ensure that it continues to make decisions based on scientific evidence, multiple former members told NOTUS. Those members said there is virtually no process in place by which the HHS secretary would give final approval to a decision made by the task force, and such control, they added, is essentially unprecedented.
“I don’t remember ever doing anything like that,” said Alex Krist, who was a USPSTF member from 2014 to 2021 and chair from 2020 to 2021.
Krist told NOTUS that the task force would occasionally give a heads up to medical groups, and a few key figures at HHS “when we were going to come out with a recommendation that we knew would get a lot of attention, usually a week or two before, … so they’re not blindsided by the media.”
“But not to ask for permission,” Krist added, just “to inform them that this is what’s coming out.”
A media contact for the current task force did not respond to requests for comment.
The USPSTF’s guidelines and recommendations have long been considered the gold standard in preventive care. According to the task force’s standards for guideline development, the panel is “independent of the federal government,” and its members are “not federal employees.” The task force members work on a volunteer basis and do not get paid.
Members of the task force are “nationally recognized experts in prevention, evidence-based medicine, and primary care,” per the task force’s website, and are appointed by the HHS secretary.
The Trump administration said in court that the Affordable Care Act allows the HHS secretary to “block” the task force’s recommendations and that “no final decision can be made that binds the public unless the secretary approves it.”
Hashim Mooppan, principal deputy solicitor general at the Justice Department, argued in court the task force is legally bound to remain independent and follow “their best scientific judgment,” but that their decisions might be influenced “by the fact that if they don’t do what [the secretary] wants, they might get removed” from the task force.
Krist told NOTUS that it was essential for the USPSTF to remain independent from the federal government.
“When you think about trust in the guidelines from clinicians and patients, if anyone feels like the government is recommending or not recommending something because, you know, they have a particular interest in in a topic, or because they’re trying to save money or cut corners, or any of those things, then all of that trust goes away,” Krist said.
The case in front of the Supreme Court revolves around the ACA’s preventive care requirement, which mandates all insurers to cover costs for preventive care services. The Trump administration inherited the case from the Biden administration, which was initially protecting the ACA by arguing that the federal government had some oversight over the task force, but focused on how a loss of coverage for preventive services could harm patients.
The Trump administration’s argument focuses solely on the government’s executive authority over the task force.
“The DOJ’s argument undermines any attempt to even suggest that they’re going to allow [USPSTF] to remain apolitical and evidence-based if the decisions made are still potentially going to lead to the firing or dismissal of the people who make those decisions,” said Susan Polan, associate executive director for public affairs and advocacy at the American Public Health Association.
Former members said that the idea that they could be removed from the task force based on their decisions was unheard of.
“It never crossed my mind,” Krist said. “We were not subject to the influence of political whims when I served. It just didn’t happen.”
Don Berwick, who was vice chair of the task force from 1990 to 1995 during the George H.W. Bush and Clinton administrations, told NOTUS that “if a political administration were to fire a task force member because, politically, they disagreed with the evidence findings, I think that would be and should be highly controversial.”
“I don’t want the government telling my doctor what to do,” Berwick continued. “I don’t want this long arm of the Trump administration expanding into a consultation with me and my doctor.”
Similarly, Ned Calonge, who was the task force chair for seven years until 2011, said that “this concept of being fired is new to me.”
“I can’t think of a single time it happened,” Calonge added.
Calonge told NOTUS that he worked with leadership in the Agency for Healthcare Research and Quality to increase “transparency and input” by starting to accept public comment on the task force’s draft research plans and draft evidence reviews in 2011. But he said that public input was not, and is not, considered a source of pressure to decide a certain way.
“I want to make sure that I state as clearly as possible that the task force wants to get it right. They want to make the recommendation that best aligns with the best science we have today,” Calonge said. “So to that degree, we looked at the public comments as a way to make sure we hadn’t missed anything.”
“The whole idea of the task force is to make decisions that are unaffected by politics, special interests or advocacy,” Calonge continued. “I think those of us who continue to watch the task force, we believe that that’s still the North Star.”
Kennedy announced in March a “a dramatic restructuring” of HHS to follow Trump’s executive order to reduce the size of the federal government. Kennedy’s move not only included “downsizing from 82,000 to 62,000 full-time employees,” but also getting rid of the Agency for Healthcare Research and Quality, where the task force was housed.
Over 40 former task force members wrote to Kennedy that “Although the Task Force itself is — by design — scientifically independent, it relies on the AHRQ to do its work,” according to a letter first reported by MedPage Today.
“This means that without AHRQ, the Task Force would not be able to review the highest-quality evidence for preventive care, or to publish its findings,” the former members said in the letter. “But more importantly, it means that without AHRQ, the Task Force’s recommendations could never reach the hundreds of thousands of primary care clinicians — and their millions of patients nationwide — who use these recommendations every day.”
The members said they wanted to make sure the secretary was aware of this so that HHS’ overhaul does not damage “the Task Force’s ability to help prevent chronic disease through primary care services.”
The agency will be merged with the Office of the Assistant Secretary for Planning and Evaluation, which is the principal advisory group to the HHS secretary, to create the new Office of Strategy.
In response to questions from NOTUS for this story, an HHS spokesperson said, “We do not comment on ongoing litigation.”
“HHS remains committed to supporting evidence-based public health initiatives through the ongoing agency realignment and restructuring efforts,” the spokesperson added.
APHA’s Polan told NOTUS she’s concerned about the new office.
“I’m afraid that by combining this into whatever new configuration they’re thinking about, it’s going to exacerbate what seems to be the plan of making the task force work much more political and steeped in the politics of the administration versus the best science and evidence,” Polan said.
The Supreme Court’s decision on Kennedy v. Braidwood is expected to come down by the end of June. A decision in favor of the Trump administration could ultimately result in the ACA preventive care requirement being upheld, while also increasing Kennedy’s influence over the health care system.
“The cuts to NIH, the stuff that’s going on in the secretary’s office around trying to take over, you know, studies or vaccines — all of that is putting politics where politics does not belong,” Berwick, who also served as administrator for the Centers for Medicare and Medicaid Services under former President Barack Obama, told NOTUS. “Having mechanisms which allow the science to be unimpeded by the moment’s political whims is very important. And I think there’s, there’s a larger and I think very unfortunate agenda here, politicizing which should not be politicized.”
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Oriana González is a reporter at NOTUS.