Time for Kennedy to kill the USPSTF
Time for Kennedy to kill the USPSTF
An obscure HHS task force is pushing faulty race and gender ideology on doctors.
One of President Donald Trump’s signature campaign promises was cleaning out the “deep state,” the bureaucratic combinations that leverage their position in the little-known corners of the federal government to attack the values and way of life of everyday Americans. One festering corner of woke bureaucracy that should draw the attention of the Trump administration has just been exposed, thanks to a Supreme Court case decided at the end of last month.
The U.S. Preventive Services Task Force (USPSTF) is a little-known advisory body of the Department of Health and Human Services (HHS), but it plays an important role in American healthcare law: Recommendations by the USPSTF must be covered in nearly all health insurance plans under the Affordable Care Act. It has used that authority to launder left-wing ideological orthodoxy into its preventive care recommendations, from gender theory (referring to women as “individuals born with a cervix”) to critical race theory (urging doctors to take into account “systemic racism”).
Established in 1984 to make recommendations to general practice physicians and public health bodies on preventive care, the USPSTF became far more important after the passage of the Affordable Care Act in 2010 gave its recommendations statutory force. The ACA mandates that
A group health plan and a health insurance issuer offering group or individual health insurance coverage shall, at a minimum provide coverage for and shall not impose any cost sharing requirements for evidence-based items or services that have in effect a rating of “A” or “B” in the current recommendations of the United States Preventive Services Task Force.
The most controversial recommendation from the USPSTF is its endorsement of preventive prophylaxis for HIV, commonly known as PrEP, for individuals at risk of infection with that disease. This population consists almost entirely of sexually active gay men, which has led a number of Christian employers who provide insurance to protest that the ACA (and its instrument, the USPSTF) are requiring them to subsidize activities they oppose on moral and religious grounds.
But the USPSTF has also, since the beginning of the Biden administration, been quietly engaged in a project of reconfiguring itself into an instrument of social justice and advocacy of left-wing ideological priors in both the private practice of medicine and in public health. In 2021, the task force released two reports detailing its plans to transform its procedures for choosing, studying, and recommending preventive services.
The first, titled “Actions to Transform US Preventive Services Task Force Methods to Mitigate Systemic Racism in Clinical Preventive Services,” laid out a proposal for “iterative changes to US Preventive Services Task Force (USPSTF) processes, methods, and recommendations and enact a commitment to eliminate health inequities for people affected by systemic racism.” These recommendations include a commitment to “describe race as a social construct with origins in slavery, oppression, exploitation, and discrimination and describes various frameworks related to racism,” to “develop an inclusive language guide as one of its steps to address systemic racism,” and to prioritize research and recommendation topics “that have high potential for advancing health equity or addressing systemic racism.”
The second report, “USPSTF Approach to Addressing Sex and Gender When Making Recommendations for Clinical Preventive Services,” is equally sinister. The report notes that making recommendations based on biological sex is vital for the practice of good medicine, but asserts that self-identification takes precedence over biological fact:
Frequently, USPSTF recommendations are sex-specific, most commonly based on the biological basis of the preventive service. For example, cervical cancer screening recommendations apply to females (individuals born with a cervix), and prostate cancer screening recommendations apply to males (individuals born with a prostate). However, many people have gender identities that differ from their sex assigned at birth. Transgender people, who were assigned male sex at birth but identify as women, or who were assigned female sex at birth but identify as men, are examples of such individuals, but there are also people with gender nonconforming or nonbinary identities who do not identify as either a man or a woman.
The report details that the task force will, as a result, end references to men and women and replace them with gender-neutral language or other “appropriate” terms such as “individuals with breasts.” The USPSTF also pledged to prioritize transgender and other populations of sexual minorities in selecting topics for research, as well as promising to hand over any relevant research and draft recommendations to gender activists for review and comment:
Once a draft research plan is created, the USPSTF will seek review by transgender, gender nonbinary, gender nonconforming, and intersex individuals and groups with specific expertise in representing these populations, as appropriate. Input will be incorporated into the final research plan.
These plans have been executed over the course of the intervening years. In a 2022 recommendation for screening adolescents for anxiety, despite noting that research shows black children are less likely to develop anxiety , the USPSTF nevertheless concluded that doctors should show them special attention because
adverse childhood experiences influence the likelihood of experiencing mental health conditions such as anxiety. Adverse childhood experiences may result from a complex interaction of familial, peer, or societal factors, including racial discrimination. These adverse childhood experiences may be blatant or subtle (eg, microaggressions) but are potentially traumatic events that, in the context of historic trauma, structural racism, and biopsychological vulnerability, can worsen mental health outcomes.
The language of “pregnant persons” replaced “pregnant women” in USPSTF recommendations for herpes screening, cancer prevention, and suicide prevention.
In 2024, the task force completed an additional milestone towards its social justice goals: the release of a comprehensive “Health Equity Framework” that would embed critical race and gender theory into every facet and stage of its operations. Like the preceding reports on gender and racism, the Health Equity Framework promises to put woke ideological considerations as the top priority, “using health equity as a prioritization criterion and engaging a diverse group of stakeholders” to shape “the entirety of its recommendation-making process.”
These frameworks continue to apply to USPSTF work undertaken during the second Trump administration. In April of this year, the task force issued a recommendation that physicians pay special attention to breastfeeding black women because of the “lasting psychological impact and stigma of enslaved Black women being forced to act as wet nurses.”
The task force is packed with Biden administration appointees devoted to the ideological capture of medicine. For example, one of the members of the board, Alicia Fernández, MD is the associate dean of Population Health and Health Equity at the University of California, San Francisco (UCSF) and the founder of UCSF’s Latinx Center of Excellence. In a speech she gave after receiving the school’s Chancellor Award for Dr. Martin Luther King, Jr. Leadership—Faculty, Fernández described her life’s work as “contributing to social justice through teaching, through research, and through clinical care.”
The continued occupation of an important advisory body in HHS—one that has the capacity to force private health insurers to cover services and procedures—by left-wing activists would be a grave oversight by the Trump administration, which has promised to end these kinds of left-wing abuses of the administrative state. Thankfully, that need not be the case. HHS Secretary Robert F. Kennedy Jr. has already shown his willingness to clean up HHS advisory bodies, replacing the department’s Advisory Committee on Immunization Practices.
Conveniently, the remedy is likely to be simple and unimpeded by the judicial strangulation that has so often met the Trump administration’s attempts to rein in the administrative state. A recent Supreme Court ruling dealing with the authority of the USPSTF under the Affordable Care Act ruled that “the Task Force members are removable at will by the Secretary of HHS, and their recommendations are reviewable by the Secretary before they take effect.”
The administration’s power to end these abuses and replace the task force members with professionals committed to the non-ideological practice of medicine has already been affirmed by the highest court in the land. It’s past time for Kennedy to heal the wounds woke deep state appointees have inflicted on HHS and start from scratch with an objective, non-ideological USPSTF.
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