In an opinion yesterday (in Braidwood Management Inc. v. Becerra), federal district judge Reed O’Connor delivered a combination of victories and defeats to a set of plaintiff employers who “for a mixture of religious and economic reasons” challenged the legality of the preventive-care mandates imposed by regulators under Obamacare.

Judge O’Connor’s ruling that a mandate to provide pre-exposure prophylaxis drugs to prevent HIV infection violated the Religious Freedom Restoration Act rights of one of the plaintiffs has gotten most of the headlines. But that ruling would appear to be a straightforward application of the Supreme Court’s recent RFRA decisions.

Much more noteworthy is O’Connor’s carefully reasoned ruling that a body you’ve probably never heard of—the U.S. Preventive Services Task Force (“PSTF”)—has been constituted in violation of the Appointments Clause of the Constitution.

As O’Connor explains, PSTF is a “body of volunteers” that makes health care recommendations. When it issues an “A” recommendation for a drug, that recommendation has the legal effect of requiring that health insurance plans cover that drug. PSTF members therefore qualify as officers of the United States for purposes of the Appointments Clause. (Pp. 18-24.) O’Connor determines that PSTF members are principal officers who, under the Appointments Clause, must be appointed by the President after confirmation by the Senate. (Pp. 25-26.) But even if they are inferior officers, the means by which they have been selected violates the Appointments Clause. (Pp. 26-27.)

Plaintiffs also challenged the compliance of two other entities—the Advisory Committee on Immunization Practices and the Health Resources and Services Administration—with the Appointments Clause. But O’Connor ruled that the HHS Secretary had ratified the challenged decisions of those entities and that it was therefore unnecessary to address the Appointments Clause claims. (Pp. 14-18.) But the HHS Secretary has no authority to ratify the PSTF’s decisions. (Pp. 18, 27-28.)