Several US Supreme Court cases from the past have significant implications for health care delivery.

I used to tell health law students that we read a few Supreme Court cases in class that cover common law and federal law. That statement doesn’t hold true over time.

Health care spending is approaching 20 percent of the economy, and health care issues have become a major part of the US Supreme Court’s 2021-2022 term. This article describes a selection of those cases to show how health care supported cases and ideas that went from unnecessary to revolutionary. I begin by reviewing cases from the past that have had the least impact on the US health care system and move on to those with the most impact.

Lesser Cases. The division included several cases involving Medicare, the federal program for the elderly and disabled. Two cases I successfully followed, American Hospital Association (AHA) v. Becerra and Becerra v. Empire Health Foundation, dealt with the agency’s interpretation of Medicare payment rules. It could have had a huge legal impact, but it didn’t. Both highlight the challenges the Court faces in the medical field.

AHA v. Becerra was a challenge to the Department of Health and Human Services (HHS) rule regarding Medicare drug reimbursement for hospitals. Under the program known as 340B, manufacturers offer drug discounts to hospitals that serve a limited number of at-risk populations. These 340B hospitals can pay insurers, including Medicare, the full cost and use the difference between the full cost and the deductible to fund other services. In a 2017 rule, HHS reduced drug reimbursements to 340B hospitals for receiving low-cost drugs.

The critics questioned whether the plan is in line with the Medicare law, which says that HHS can pay based on the costs of hospital purchases, if HHS collects research data on those costs, or, if not, based on sales prices.

Justice Brett Kavanaugh’s opinion in a concurring court offered a simple reading of the law. “As a matter of principle and policy,” he wrote, “this case is straightforward: Because HHS did not conduct an audit of hospital costs, HHS acted illegally by reducing reimbursement rates for 340B hospitals.”

Although HHS is expected to pay 340B hospitals higher rates over the years in question, the agency is now collecting survey data that would confirm that lower rates are moving forward.

In the second case of Medicare, Empire Health Foundation, the court considered another payment plan called “disproportionate share hospital” adjustment, or DSH. Hospitals that serve a large portion of low-income Medicare and Medicaid patients receive additional federal funding. In explaining how to read this section, the law refers to patients who are “eligible” for Medicare and “eligible for” Medicaid. The lawsuit was argued to be inconsistent with a 2006 HHS rule that redefined what it means to be “eligible” for Medicare.

After debating the issue’s complexity, Justice Elena Kagan wrote a majority opinion — joined by Justices Clarence Thomas, Sonia Sotomayor, Amy Coney Barrett, and Kavanaugh — that said the HHS law is consistent with Medicare-related language. the law.

These cases may be an opportunity for the Court to make an important landmark in respecting the leadership or the doctrine of constitutional interpretation. Rather, in both cases, the Court’s opinion was a straightforward interpretation of the statute.

High Courts. However, several other cases will have a lasting impact on legal theory, and on people’s lives.

The first concerns whether a wrongfully injured person can recover medical expenses. In Gallardo v. Marstiller, the court said that the Medicaid Act allows states to seek reimbursement from medical malpractice for the costs of care the Medicaid program spends — both past and future costs. This reimbursement is controversial because it often results in less compensation for the plaintiffs’ injuries, as was the case in this case where a 13-year-old boy was hit by a truck while getting off his school bus and was left permanently disabled. The family sought $20 million in damages and received $800,000, of which Florida took $300,000, leaving the family with a large amount of money for care.

In addition to Gallardo, in January the Supreme Court ruled on two cases related to the Biden Administration’s vaccine. In NFIB v. Department of Labor, the court suspended the Occupational Safety and Health Administration’s (OSHA) mandate that all employers with more than 100 employees establish an employee vaccination program or require employees to be tested weekly and wear masks. In Biden v. MissouriHowever, the Court on the same day allowed the Centers for Medicare and Medicaid Services (CMS) to continue requiring hospitals that receive health care funds to ensure that employees are vaccinated against COVID-19, unless they are exempt from medical treatment. or religious reasons.

The court concluded that OSHA exceeded its authority to promote workplace safety under the Occupational Health and Safety Act, while CMS acted within the authority Congress had given it to establish requirements for participation in state health care programs. The Biden The opinion described the CMS rule as appropriate to protect patients and consistent with past practices.

While OSHA’s decision may delay vaccine adoption, its biggest concern comes from how it will force future regulators to deal with unprecedented emergencies. Foreshadowing the announcement of the big question doctrine, as discussed below, the Court called OSHA’s rule “a serious interference with the lives – and health – of many workers.”

Strong Cases. For many people, Dobbs v. Jackson Women’s Health Organization it was a landmark decision during the Court’s tenure, when it struck down the right to abortion first proclaimed in 1973. Roe v. Wade. Another article in this article explains DobbsMany effects on the constitution. The ruling has also raised many questions about health care that lawyers and courts will need to answer: What reproductive information does HIPAA protect? Can employer health plans provide abortion coverage? Can women get abortions from outside the state?

Although it is Dobbs, which may be the biggest health problem in the sector West Virginia v. Environmental Protection Agency, a story about air quality regulations that seem to have nothing to do with health care on land. In his 6-3 majority opinion, Chief Justice John Roberts declared clearly for the first time that the “great question doctrine” requires that, in “extraordinary circumstances” of “economic and political circumstances,” an agency must show “the clear authorization of Congress .” In confirming this theory, Roberts reframed many of the cases as major questions, including NFIB v. Department of Labor the decision discussed above.

HHS, which includes the Food and Drug Administration, the Centers for Disease Control and Prevention, CMS, and many others, is one of the most important agencies that is constantly focused on political and economic issues. The In the west Virginia The decision will prevent HHS from overseeing strict, flexible, and often critical regulations, including federal abortion laws after—Dobbs and future efforts to manage public health emergencies like COVID-19.

Summary. Health care is at the center of political contests, ethical battles, and, increasingly, important Supreme Court decisions. This small sample of the 2021-2022 cases shows how the Roberts Court is shaping the future of health care law and policy and, in turn, how health care law is serving as the fodder for important religious reform.

Allison K. Hoffman

This article is part of a ten-part series titled The Supreme Court’s 2021-2022 Regulatory Term.

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