RFK Jr. Gets Slapped Down in Court | The Waiting Room

His anti-vax agenda just got the ax from a federal judge. And why is Trump obsessed with Health Savings Accounts? Follow the money.

Charles Gaba is a health care analyst who tracks policy and politics at ACASignups.net. Subscribe to his Substack!

Greetings, Lincoln Square readers!

In the last edition, I posted highlights (lowlights?) from New Jersey’s 2026 Open Enrollment report, noted that Oklahoma & Oregon plan on moving off the federal ACA exchange onto their own platforms, and broke out Medicare & Medicaid/CHIP enrollment as of last November.

---

One of the biggest healthcare stories last week was the latest twist in an ongoing saga which I didn’t even get around to writing about … which is ironic given that I had previously written perhaps a dozen articles about this very issue dating all the way back to June 2021.

The very, very short version goes like this:

One of the key provisions of the Patient Protection & Affordable Care Act is the “preventative services coverage mandate,” which states that all ACA-compliant major medical healthcare policies must provide coverage of a long list of Preventative Services at no out of pocket cost to the enrollee. That means the patient doesn’t have to pay any co-pay or coinsurance for these services as long as they’re performed by an in-network healthcare provider.

The list of services ranges from regular checkups, cholesterol screenings & colorectal cancer screenings for everyone to mammograms, cervical cancer screenings for women, preeclampsia prevention and breastfeeding support for pregnant women and so on.

Oh yeah … and it also includes immunizations for chickenpox, diphtheria, hepatitis, measles, mumps, whooping cough, shingles, tetanus and, yes, COVID-19, among others.

On top of this, the ACA’s preventative services mandate requires coverage of PrEP HIV prevention medication for those at high risk of HIV … which, as stupid as it may sound, didn’t go over very well with some parties.

And so it came to pass that in early 2021, a lawsuit was filed which claimed that the ACA’s preventative services mandate was unconstitutional because the law didn’t specify those services and instead assigned the authority to do so to three government bodies … the members of whom the suit claimed weren’t legally authorized to do so in the first place.

As Ian Millhiser explained at the time:

... Several provisions of the Affordable Care Act require group and individual health plans to cover various preventive treatments and to not “impose any cost sharing requirements,” such as copays, for them. When Congress wrote Obamacare, however, it did not itemize which treatments must be covered. Instead, it delegated that power to three different government bodies.

What’s at issue here is whether or not the three governmental bodies referred to (the Preventive Services Task Force (PSTF), the Advisory Committee on Immunization Practices (ACIP) and the Health Resources and Services Administration (HRSA)) have the Constitutional authority to dictate what services/treatments have to be covered by health insurance carriers or not.

As you may have guessed, of course, there’s a deeper agenda at play here:

The plaintiffs in Kelley are an array of religious conservatives, and what Judge O’Connor labels as “Free-Market Plaintiffs,” who wish to purchase health plans that do not cover some of the preventive services that insurers are currently required to cover.

Some of these plaintiffs, for example, object to a requirement that insurers pay for pre-exposure prophylaxis (“PrEP”), drugs that are very effective in preventing the transmission of HIV, because those plaintiffs believe that PrEP “encourage[s] and facilitate[s] homosexual behavior.”

I’m not going to bore you with the legal ping pong which followed; suffice it to say that this case dragged out over the entire span of the Biden Administration … until it eventually landed at the steps of (of course) … the U.S. Supreme Court.

As a reminder of how high the stakes were, here’s a refresher from Sabrina Corlette:

… millions could, in very short order, lose access to no-cost early cancer screenings, mental health assessments, statins for heart disease, PreP to prevent HIV, and many more life-saving preventive services.

... One of the ACA’s] reforms was a requirement that employer-based health plans and health insurers cover, without cost-sharing, high-value preventive services recommended by any one of three government panels, each composed of physicians and clinical experts. Coverage for more than 100 services has been mandated so far, including cancer screenings, childhood and adult immunizations, contraceptives, and mental health assessments.

Congress included the preventive services provision in the ACA because, when the law was enacted, many insurers did not cover critical preventive measures, or they imposed financial barriers, such as deductibles, copayments, or coinsurance, which limited their use. The preventive services coverage mandate is now one of the ACA’s most widely recognized, and popular, benefits, reaching 224 million people. It has led to the increased use of prevention, improved health outcomes, and reduced racial disparities in access to care.

In Braidwood Management v. Becerra, the plaintiffs challenged the constitutionality of the ACA’s preventive services provision.

Well, the U.S. Supreme Court did indeed finally hear the case just under a year ago in April 2025 …

The Supreme Court seemed likely to uphold a key preventive-care provision of the Affordable Care Act in a case heard Monday.

Conservative justices Brett Kavanaugh and Amy Coney Barrett, along with the court’s three liberals, appeared skeptical of arguments that Obamacare’s process for deciding which services must be fully covered by private insurance is unconstitutional.

The case could have big ramifications for the law’s preventive care coverage requirements for an estimated 150 million Americans. Medications and services that could be affected include statins to prevent heart disease, lung cancer screenings, HIV-prevention drugs and medication to lower the chance of breast cancer for high-risk women.

… And on the surface it sounded promising for shooting down the plaintiff’s claims, which mean that the U.S. Preventive Services Task Force could indeed continue to decide which preventative services ACA insurance policies have to cover at no out of pocket cost after all. Great news, right?

Well, yes ... except for one thing:

... The Trump administration defended the mandate before the court, though President Donald Trump has been a critic of the law. The Justice Department said board members don’t need Senate approval because they can be removed by the health and human services secretary.

This set off MASSIVE red alerts in my head at the time:

The good news is that the PSTF could continue to do its job. The bad news was that anti-vaxxer and complete nutjob Robert F. Kennedy Jr. became the one who gets to decide who serves on the PSTF.

According to the PSTF website itself:

The Task Force is made up of 16 volunteer experts in the fields of preventive medicine and primary care, including internal medicine, family medicine, pediatrics, behavioral health, obstetrics/gynecology, and nursing. Most of our members are practicing clinicians. To develop recommendations, we use our own expertise and routinely invite the input of disease experts and specialists. We also invite input from stakeholders and the public.

And who decides who those 16 experts are?

The Agency for Healthcare Research and Quality (AHRQ) convenes the Task Force and provides scientific, administrative, and dissemination support.

And who decides who’s in charge of the AHRQ?

The 20-member panel is comprised of private-sector experts who contribute a varied perspective on the health care system and the most important questions that AHRQ’s research should address in order to promote improvements in the quality, outcomes, and cost-effectiveness of clinical practice. The private-sector members represent health care plans, providers, purchasers, consumers, and researchers.

Also serving in an ex-officio capacity are principal representatives of seven Federal agencies that address health care system issues: The National Institutes of Health (NIH); the Department of Defense (Health Affairs) (DoD); the Centers for Disease Control and Prevention (CDC); the Department of Veterans Affairs (VA); the Office of Personnel Management (OPM); the Food and Drug Administration (FDA); the Centers for Medicare & Medicaid Services (CMS, formerly the Health Care Financing Administration [HCFA]); and the Assistant Secretary for Health.

All of those ex-officio capacity members are, of course, appointed by the President ... in this case Donald Trump. Lovely. But what about the private-sector members who actually have the authority to ...

Private-sector members are appointed by the Secretary, HHS, to serve 3-year terms. A list of current members follows. Biographies are available by selecting the member’s name.

Oh. Never mind.

Meanwhile, what’s been happening with the AHRQ recently?

On April 1, the Trump administration slashed the organization that supported that research — the Agency for Healthcare Research and Quality, or AHRQ — and fired roughly half of its remaining employees as part of a perplexing reorganization of the federal Health and Human Services Department.

You can see where this was headed.

Sure enough, everything I was afraid of came to pass in short order:

Health and Human Services Secretary Robert F. Kennedy Jr. has fired all 17 members of a committee that advises the federal government on vaccine safety and will replace them with new members, a move that the Trump administration’s critics warned would create public distrust around the government’s role in promoting public health.

At issue is the Advisory Committee for Immunization Practices, which makes recommendations on the safety, efficacy and clinical need of vaccines to the Centers for Disease Control and Prevention. It comprises medical and public health experts who develop recommendations on the use of vaccines in the civilian population of the United States.

... Kennedy’s decision marks a reversal from what a key Republican senator said the Trump Cabinet member had promised during his confirmation hearings earlier this year. Sen. Bill Cassidy, R-Louisiana, chair of the Senate Committee on Health, Education, Labor, and Pensions, said Kennedy had promised to maintain the advisory committee’s current composition.

A month later, via the Wall Street Journal:

RFK Jr. to Oust Advisory Panel on Cancer Screenings, HIV Prevention Drugs

The task force determines which preventive services insurers must cover at no cost to patients

Health and Human Services Secretary Robert F. Kennedy Jr. is planning to remove all the members of an advisory panel that determines what cancer screenings and other preventive health measures insurers must cover, people familiar with the matter said.

Kennedy plans to dismiss all 16 panel members of the U.S. Preventive Services Task Force because he views them as too “woke,” the people said.

The White House has made a priority of targeting initiatives that promote diversity equity and inclusion, or DEI, in everything from artificial intelligence to health research grants.

And who did RFK Jr. replace these committee members with? Well, among others, it included these two charming fellows:

Martin Kulldorff (born 1962) is a Swedish biostatistician. He was a professor of medicine at Harvard Medical School from 2003 until his dismissal in 2024. He is a member of the US Food and Drug Administration’s Drug Safety and Risk Management Advisory Committee and a former member of the Vaccine Safety Subgroup of the Advisory Committee on Immunization Practices at the Centers for Disease Control and Prevention.

In 2020, Kulldorff was a co-author of the Great Barrington Declaration, which advocated lifting COVID-19 restrictions on lower-risk groups to develop herd immunity through infection before vaccines became available, while promoting the fringe notion that vulnerable people could be simultaneously protected from the virus. The declaration was widely rejected, and was criticized as being unethical and infeasible by Tedros Adhanom Ghebreyesus, the director-general of the World Health Organization.

Robert Wallace Malone (born October 20, 1959) is an American physician and biochemist. His early work focused on mRNA technology,[3] pharmaceuticals, and drug repurposing research. During the COVID-19 pandemic, Malone promoted misinformation about the safety and efficacy of COVID-19 vaccines.

This, of course, led to a series of policy changes last fall & winter, including:

• May 2025: RFK Jr. ends Covid vaccine recommendations for healthy children, pregnant people

• September 2025: CDC panel abandons COVID vaccine recommendation, saying it’s a personal choice

• December 2025: ACIP Votes to End Routine Hep B Birth Dose Recommendation

• January 2026: CMS to stop requiring states to report childhood vaccination levels

… and so on. Things were looking pretty grim.

That brings us to the story I missed last week:

Judge Strikes Down Kennedy’s Vaccine Policies

In a severe blow to the Trump administration’s health agenda, a federal judge in Massachusetts on Monday blocked the government from implementing a series of decisions on vaccines made over the last year by Health Secretary Robert F. Kennedy Jr.

The ruling also reversed, at least for the time being, all decisions made by the panelists that Mr. Kennedy appointed to the Advisory Committee for Immunization Practices, which makes recommendations on which vaccines Americans should take. The court decision will prevent the committee from meeting later this week, as it was scheduled to do.

The judge’s ruling brought an abrupt halt to the major changes that Mr. Kennedy, who has long been skeptical of vaccines, had set in motion, upending national vaccine policy and making sweeping revisions to the recommendations for what shots are given and when. Those included cutting down the number of diseases covered by routine immunization, and restricting access to Covid vaccines, two pillars of Mr. Kennedy’s vaccine agenda.

HOORAY!!

Obviously, there will likely be more twists and turns (including an appeal by the federal government), but for the moment it seems that sanity has reestablished itself.

This, however, was apparently enough to break the spirit of at least one of the anti-vaxxers brought onboard by RFK Jr, anyway. Remember Robert Malone, who I mentioned above? Yeah, he’s decided that he’s out:

Dr. Robert Malone, vice chair of the federal committee that recommends vaccines to Americans, angrily resigned his position on Tuesday.

… The Department of Health and Human Services has indicated that it will appeal the ruling but has not said when. Dr. Malone indicated that he would not rejoin the committee even if the ruling were to be overturned or if Mr. Kennedy announced a new slate of advisers.

“If offered the opportunity to participate in a relaunched A.C.I.P., I will respectfully decline,” Dr. Malone said in a text message.

… “Hundreds of hours of uncompensated labor, incredible hate from many quarters, hostile press, internal bickering, weaponized leaking, sabotage,” he added. “I have better things to do.”

Yeah, you go ahead and do those things, Dr. Malone.

---

In other news …

One of the most insanely stupid provisions of the ACA just became slightly less stupid.

The very short version is that in order to comply with the Hyde Amendment (which prohibits federal funds from being used to pay for abortions in nearly all cases), the ACA established a rather convoluted workaround which resulted in several hundred million dollars sitting around in various “Abortion Funds” nationally doing nothing but gathering dust (and interest)… until now.

A new KFF survey confirms everything I’ve been warning about for months.

• 80% of all enrollees have higher overall healthcare costs (duh), with over 50% reporting much higher costs

• Over half are being forced to cut back on other types of household spending to afford medical expenses

• 17% aren’t confident that they’ll be able to afford to pay their monthly premiums for the rest of 2026

• 4% of returning Marketplace enrollees say they have yet to pay their first premium for 2026

• 9% of those enrolled as of 2025 say that they are ALREADY currently uninsured

… and more

The mystery behind Trump’s obsession with expanding HSAs revealed

Judd Legum of Popular Information came across a pretty clear explanation of why the GOP has been trying to ram Health Savings Accounts down everyone’s throat over the past year; as you’ve probably guessed, it involves kickbacks and corruption in the Trump Regime.

Medicare Advantage enrollment DROPPED for first time in 13 years

After seeing enrollment increase for 155 months straight, enrollment in the privately-administered version of Medicare, which recently broke past 50% of total Medicare enrollment, dropped slightly in December.

Minnesota: February MNsure report provides more warning signs re both effectuations & coverage levels

Effectuated enrollment in ACA exchange coverage was 8.6% lower in Minnesota in February than it was at the same point a year earlier; the percent of households receiving financial assistance has dropped from 61% to 50%; and enrollment in high-deductible Bronze plans has increased 11% while lower-deductible Silver/Gold enrollment is down 12%.

New York: NYSoH announces federal approval to revert Essential Plan back to BHP authority

Several years ago, New York overhauled & expanded their Basic Health Plan program to cover up to half a million more residents. Unfortunately, due to policy changes included in the GOP’s so-called “One Big Beautiful Bill Act” (aka the #BigUglyBill), half the funding for the program has been cut, forcing the state to downgrade it to the original parameters.

As a result, ~450,000 New Yorkers who earn 200 - 250% of the Federal Poverty Level will be kicked off Essential Plan coverage this summer & will instead have to enroll in ACA exchange coverage…which will cost most of them far more than they’re paying today due largely to the GOP letting the enhanced tax credits expiring back in January.

And with that, I’ll see you again in two weeks!