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The Trump administration’s efforts to influence U.S. medical practice have drawn new attention to the United States Preventive Services Task Force.
Little known by the public, the USPSTF plays an important role in U.S. primary care and health insurance coverage, evaluating a broad body of scientific research to make evidence-based recommendations about ways to prevent disease and prolong life. Under a provision in the Affordable Care Act, health insurers are required to cover the full cost of services that are highly recommended by the USPSTF.
The USPSTF is made up of 16 volunteer members drawn from several disciplines of medicine, including primary care, behavioral health, geriatrics, internal medicine, nursing, obstetrics and gynecology, preventive medicine, and pediatrics. Members, who are appointed by the U.S. Department of Health and Human Services, traditionally serve staggered four-year terms so that more experienced members can train newer ones.
Many physicians value and strongly support the work of the USPSTF, even in cases where they question a particular recommendation — such as when it raised the recommended age for when mammogram screenings should start.
That’s why they have raised alarms about the prospect of major changes to the task force. Many medical professionals have feared changes to USPSTF following U.S. Secretary of Health and Human Services Robert F. Kennedy’s June ouster of the 17 members of the Advisory Committee for Immunization Practices. Housed at the Centers for Disease Control and Prevention, ACIP offers recommendations that shape insurance coverage of vaccines.
And on July 25, The Wall Street Journal exclusively reported that Kennedy intends to remove all members of the USPSTF, too. (“No final decision has been made on how the USPSTF can better support HHS’ mandate to Make America Healthy Again,” an HHS spokesperson told The Journalist’s Resource in a July 28 e-mail, using the Trump administration’s slogan for its work on public health.)
In a July 27 appeal to keep the current USPSTF members in place, The American Medical Association noted that the task force’s recommendations “dictate coverage policy for health insurers nationwide.”
Dismissing the USPSTF members would reflect “an alarming erosion in reliance on scientific integrity and evidence-based health expertise in America’s public health infrastructure and will have grave consequences,” according to a July 28 joint statement from the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American College of Physicians, and the American Psychiatric Association.
The news also prompted Sen. Angus King, an independent representing Maine, to introduce a resolution to preserve the nonpartisan panel. Seven Democrats, including Elizabeth Warren of Massachusetts, so far have supported it.
It’s important for journalists covering health care in the U.S. to ground themselves in background information about the USPSTF. Here we’ll address five questions, including:
How does the panel produce its reports and recommendations?
What are USPSTF grades, and why do they matter for health care access and insurance coverage?
What are the possible implications of a recent Supreme Court decision about the USPSTF?
What are the “mammography wars”?
In 1976, Canada formed its Task Force on the Periodic Health Examination, a forerunner to that nation’s current Task Force on Preventive Health Care. That impressed people seeking to establish what’s called evidence-based medicine in the United States, with a greater reliance on guidelines based on study results.
HHS in 1984 created the first version of the USPSFT. In 1989, the task force published its first report, Guide to Clinical Preventive Services: An Assessment of the Effectiveness of 169 Interventions.
It then was disbanded.
The second USPSTF was assembled in September 1990 and met through April 1994.
In 1999, Congress sought to provide more resources to help doctors weigh the benefits and risks of medical treatments. It wrote a law firmly establishing the USPSTF as a panel with a mandate to review the scientific evidence about the effectiveness of treatments.
In the 2024 version of its annual report to Congress, the USPSTF said it has produced a total of almost 300 recommendations.
How does the panel produce its reports and recommendations?
The task force has a formal and extensive process for initiating or reconsidering its recommendations.
The panel considers guidelines developed by specialty groups, such as the views of radiologists on mammography, and also does its own wide sweep of published studies.
To bolster their own experience in evaluating studies and other research, the members of the task force work with outside groups such as the RTI International–University of North Carolina Evidence-based Practice Center. Based on expertise and interest, several task force members lead each review. Staff from the Agency for Healthcare Research and Quality assist as well.
The USPSTF will release its draft work plan for public comment, showing the framework for its intended analysis and key questions to be considered. The response to comments from the public often leads to changes and refinements in the task force’s recommendations. Once that’s set, an extensive review of published research follows. In some cases, the USPSTF will try to answer questions for which there is not adequate data from clinical trials, seeking to supplement their research with complex statistical analyses known as models.
Final recommendations are published in JAMA, including evidence summaries and descriptions of modeling studies, if any were used. The task force also posts online a summary of its response to comments submitted and a note identifying further research needed about the service being considered.
The USPSTF has updated many of its recommendations repeatedly, seeking to incorporate findings on new research. For example, the task force issued its initial recommendations on breast cancer screening in 1996. Perhaps the most famous of the USPSTF’s work, these breast cancer recommendations were updated in 2002, 2009, 2016 and 2024.
Reporting tip: Avoid giving the impression that any set of recommendations represents the final word on a topic. That way your audience won’t be surprised to see news about revised guidelines in the future.
What are USPSTF grades, and why do they matter for health care access and insurance coverage?
The USPSTF assigns letter grades to preventive care services, based on its evaluation of the evidence. In some cases, the task force recommends services; in others, it recommends against their use. It also states when it doesn’t have enough evidence to make a call.
The task force does not directly consider insurance coverage and access in its deliberations, focusing instead on medical evidence. But Congress has invested the task force’s work with significant clout in shaping U.S. health care.
In 2003, lawmakers said Medicare would cover certain tests for cardiovascular risks if the USPSTF recommended them. This was part of the Republican-led law that created the Medicare drug benefit. This law was passed with support from some Democrats in the House and Senate. In 2010, Democrats in Congress gave greater clout to the USPSTF. They created a mandate, as part of the Affordable Care Act, that requires health insurers to pick up the full cost of services that get an “A” or “B” grade from the USPSTF.
The USPSTF uses four grades and an “insufficient” rating. Here’s what the ratings mean:
- A: There is high certainty that the net benefit is substantial. The USPSTF recommends clinicians offer or provide this service.
- B: There is high certainty that the net benefit is moderate, or there is moderate certainty that the net benefit is moderate to substantial. The USPSTF recommends clinicians offer or provide this service.
- C: There is at least moderate certainty that the net benefit is small. USPSTF says clinicians may want to offer or provide this service for selected patients depending on individual circumstances.
- D: There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits. USPSTF discourages the use of this service.
- I Statement: The current evidence available is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.
As of July 2025, there were about 50 USPSTF recommendations with “A” and “B” grades. These include screenings for certain cases of cancer and hypertension, as well as counseling about exercises to prevent falls for some people 65 years or older.
As of 2020, about 151.6 million people in the United States were eligible for USPSTF-recommended services without facing co-pays, according to a 2022 federal estimate.
What are the possible implications of a recent Supreme Court decision about the USPSTF ?
Some conservatives have challenged the approach of USPSTF, driven in part by opposition to its strong recommendation of preexposure prophylaxis, or PrEP, to decrease the risk of HIV infection among people with a high risk of contracting it. This recommendation has an “A” grade, meaning insurers are required to cover the full cost of PrEP.
In a July 9 column for The American Conservative, Associate Editor Joseph Addington cited the PrEP recommendation, among other concerns, when he called on Kennedy to replace the current members of the USPSTS.
A legal fight about the role of USPSTF in this matter recently reached the Supreme Court in a case known now as Kennedy v. Braidwood.
Steven Hotze, a physician who promotes alternative medicine and opposes homosexuality, objected to the insurance mandate triggered by this USPSTF recommendation. Braidwood Management, a firm owned by Hotze, provided insurance for about 70 employees, making it subject to the mandate to cover PrEP should any of its employees want to take it. Hotze opposed the requirement to cover PrEP on religious grounds.
To fight this mandate, Hotze and his attorneys challenged whether the USPSTF members had been properly appointed. They argued that the ACA insurance mandate gives the USPSTF so much power that the Senate should be required to approve the people chosen to serve on the panel.
The Supreme Court on June 27 issued a 6-3 decision that rejected this argument.
The Court held that USTSTF members do not require Senate confirmation. Thus, RFK’s ability to appoint and remove members at will is legal under the Constitution.
The HHS secretary also has the power to block USPSTF recommendations before they take effect, wrote Justice Brett Kavanaugh, in the majority opinion.
Kavanaugh’s opinion echoed an argument that attorneys representing the Trump administration made in a Feb. 18 amicus brief, which stressed the point that HHS has oversight over the task force.
Terminology explained: What’s an amicus brief? Before deciding a case, courts routinely accept written filings from parties that establish they have a valid interest in cases, even if they are not directly involved in them. These filings, known as amicus curiae briefs, are submitted in hopes that the courts will consider them when in their decisions. The Supreme Court posts the amicus briefs it receives on its website, organized by case. If you cover health care or legal systems in the U.S., consider following up with people who submitted briefs. Reporters seeking local angles for stories on the impact of any given Supreme Court decision may find them in these amicus briefs.
The HHS secretary “has authority to ensure that the Task Force considers issuing particular recommendations,” they wrote. “The Secretary may propose a recommendation topic and remove Task Force members if they refuse to consider it. And the Secretary may issue regulations mandating certain recommendation priorities.”
Kavanaugh noted in the Supreme Court opinion that there’s a lag of at least a year for the implementation of the mandate triggered by “A” and “B” recommendations. This gives HHS secretaries time to review USPSTF recommendations and block them from going into effect, if they so choose, Kavanaugh wrote.
That ACA provision delaying the mandate “serves in part to give issuers and plans time to incorporate preventive services for the next policy or plan year,” wrote lawyers for the Trump administration in an earlier court filing.
“But the Secretary’s authority to establish such an interval for that purpose does not deny the Secretary the ability to invoke that authority for the additional purpose of allowing him time to review—and then deny binding effect to—recommendations, or to remove and replace the Task Force members who issued them,” the lawyers wrote.
It’s not clear yet what Kennedy, “with his notoriously eccentric views about medicine and science,” will do with this newly affirmed control of USPSTF, writes Nicholas Bagley, a professor at the University of Michigan who studies health care law, in a July 23 Perspective article for The New England Journal of Medicine.
“Kennedy could push the USPSTF to withdraw the PrEP recommendation,” Bagley writes. “He has already eliminated or reassigned staff from the Office of Infectious Disease and HIV/AIDS Policy.”
The health secretary “may also come to see the USPSTF as a vehicle for guaranteeing coverage of medical care of dubious value,” Bagley writes.
For example, Kennedy has been seeking to increase use of blood glucose monitors for people who don’t have diabetes, Bagley notes.
“One way to cover those costs would be to instruct USPSTF members to give an “A” or “B” rating to the use of qualifying wearables — a decision that would broadly inflate the price of health insurance for Americans,” Bagley writes. “If task force members refuse to adopt such a rating, they could be dismissed and replaced by members who will.”
What are the “mammography wars”?
The ACA insurance mandate has proven popular with members of both parties, despite lack of GOP support for the ACA in 2010.
There have been bipartisan protests from lawmakers in cases where USPSFT recommendations are more conservative than those favored by medical specialty organizations.
For example, the USPSTF in 2009 shifted the starting age for its mammography recommendation from 40 to 50, drawing criticism that this could discourage screening in younger women.
Many Republicans, including Sen. Marsha Blackburn of Tennessee, joined Democrats in keeping in place a federal mandate that insurers cover mammography for women in their 40s, despite USPSTF giving the screening a “C” grade for recommending screening for those younger than 50.
In 2024, the USPSTF changed its stance again, giving a “B” recommendation for starting mammography at age 40.
But that recommendation has not ended the intense debate, sometimes called the “mammography wars.” The American College of Radiology (ACR) welcomed the USPSTF’s lowering starting age in 2024, although it disagrees with the recommended frequency of the screening.
The USPSTF recommends women get screened for breast cancer every other year, starting at age 40 and continuing through age 74, to reduce their risk of dying from this disease. ACR argues that women should get annual screening.
The USPSFT’s 2024 recommendations on breast cancer screening also drew protests from some doctors, including top experts in evidence-based medicine. They question the decision to recommend starting breast cancer screening at 40.
“A change in mammography recommendations would be supported if there were evidence that breast-cancer outcomes were worsening or if there were new evidence that screening younger women had clear benefits. In fact, neither condition applies,” writes Steven Woloshin of Dartmouth University in a 2023 perspective piece published in the New England Journal of Medicine.
Woloshin and coauthors urged a reconsideration of the plan to lower the starting age for mammography screening.
“The Task Force’s models are insufficient to support a new public health imperative, given the limited benefits and such common and important harms to healthy women,” they write. “It would be better to allow women to make their own decisions based on their own assessment of the data and their values — and to redirect resources to ensuring that all women with breast cancer receive the best and most equitable treatment possible.”
Among those who have studied USPSTF most closely is Barron Lerner, a physician, ethicist and historian of medicine at New York University. In a 2022 article for The Milbank Quarterly, Lerner published an in-depth examination of missteps in the USPSTF’s handling of its controversial 2009 breast cancer screening recommendation.
But, in a July 15 blog post for the nonprofit Hastings Center for Bioethics, titled “The Scientific Good Guys: Let’s Save the U.S. Preventive Services Task Force,” Lerner argues for keeping its current members in place.
Lerner notes that he and other researchers have been keeping close watch on the task force for many years and have challenged some assumptions the task force has made.
“But I would presume that almost all of these critics are upset with Kennedy’s interference with the task force,” Lerner writes. “After all, this is an organization that has prioritized the best available science for decades and hired data-driven methodologists without known biases to review that science. You can’t get much better than that for apolitical.”