How the Supreme Court's Chevron deference ruling could affect healthcare

The Supreme Court in a 6-3 ruling overturned a 40-year-old legal precedent known as Chevron deference, the Washington Post reported June 28.  

Chevron deference, which emerged from a 1984 court case, stipulated that when disputes arise over regulation of an ambiguous law, judges should defer to federal agency interpretations so long as those interpretations are reasonable.

Chief Justice John Roberts wrote for the majority that the framework has proved "unworkable" and allowed federal agencies to change course even without Congress' discretion, according to the report. 

Suhasini Ravi, then an associate at Washington, D.C.-based Georgetown University's O'Neill Institute for National and Global Health Law, wrote in an October article that the "prospect of overruling Chevron is especially concerning in healthcare policy, where agencies must leverage their expertise to address emergencies, adapt to ever-changing technology and improve health outcomes." She is now a director of health policy at the White House, according to her LinkedIn page. 

Politico reported in May that experts expect the rollback of Chevron to lead to more legal challenges to Medicare payment. Leigh Feldman, director at McDermott+Consulting, told the outlet that Congress might have to be more prescriptive in legislation to direct agencies like HHS how it wants laws to be implemented to avoid challenges. Jeffrey Davis, health policy director at McDermott+Consulting, added that if laws get more prescriptive, "outside stakeholders and interest groups could have a larger role in helping to craft specific provisions in the legislation."

Reshma Ramachandran, MD, an assistant professor of medicine at Yale, argued in an amicus brief that many pandemic-era rules and FDA regulations regarding pharmaceutical and medical devices could be at risk with Chevron's overturning, according to Politico.  

In January, a group of organizations including the American Cancer Society and the American Heart Association, submitted a brief in support of Chevron deference. They argued that overturning the precedent could have "an enormous impact on the administration of federal programs — including Medicare, Medicaid and CHIP — that are crucial to public health." 

The groups said that the "competent and stable administration of these programs depends on the deep expertise of the agencies to which Congress has assigned the responsibility of promulgating rules and rendering interpretive decisions in connection with the implementation of these complex statutes, which serve nearly half the U.S. population, in every geographic region, of every income level, and with every kind of medical and care need.

"The disruption to the healthcare system that would occur during the transition to such a post-Chevron world — as litigants seek to reopen disputes involving dozens of programs and billions of dollars that were previously resolved through application of the Chevron doctrine —  would be enormous." 

Opponents of Chevron told the Supreme Court that the framework unfairly tips the scale of litigation by requiring judges to systematically favor government regulators over those challenging the regulations, according to the Post. They also argued that Chevron allowed federal agencies to impose different rules each time a new administration takes over, leaving judges with little choice but to defer to the changing interpretations of agency officials.  

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