Experts say the US Supreme Court's ruling Friday to overturn the decades-old "Chevron doctrine" could severely restrict the ability of federal agencies to regulate all aspects of health care.
Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation, wrote on X, "my worry is that it will paralyze policymaking in health care and other areas," because "Congress will try to fill in more details, making it harder to pass legislation." He also wrote that federal agencies "will become very cautious in using their regulatory authority."
In their 6-3 opinion reversing the "Chevron doctrine" — which has been followed since a 1984 Court opinion — the Justices said that the judiciary should no longer have to defer to federal agency interpretations of laws. Existing federal law "requires courts to exercise their independent judgment in deciding whether an agency has acted within its statutory authority," said the Court, in stating why Chevron should be overruled.
Writing for the majority in the combined cases — Relentless v Department of Commerce and Loper Bright Enterprises v Raimondo — Chief Justice John Roberts, Jr. wrote that "agencies have no special competence in resolving statutory ambiguities. Courts do."
In a dissenting opinion, Justice Elena Kagan said the decision was a judicial power grab and would result in a "jolt to the legal system." She was joined by Justices Sonia Sotomayor and Ketanji Brown Jackson.
The opinion will have many repercussions, said lawyer and Supreme Court watcher Amy Howe. The Chevron ruling has been "one of the most important rulings on federal administrative law, cited by federal courts more than 18,000 times," she wrote on her blog.
For example, without the longstanding deference to agencies under Chevron, health care providers may have more opportunities to challenge how federal officials set Medicare reimbursement for hospital procedures or prescription drugs, Baker Donelson health care attorneys McKenna Cloud and Thomas Barnard wrote in an analysis.
Seventeen health organizations issued a joint statement signaling their disappointment.
"We anticipate that today's ruling will cause significant disruption to publicly funded health insurance programs, to the stability of this country's healthcare and food and drug review systems, and to the health and well-being of the patients and consumers we serve," wrote the organizations, which included American Academy of Pediatrics, American Cancer Society, American Cancer Society Cancer Action Network, ALS Association, American Heart Association, American Lung Association, American Public Health Association, American Thoracic Society, Bazelon Center for Mental Health Law, Campaign for Tobacco-Free Kids, Child Neurology Foundation, Epilepsy Foundation, Muscular Dystrophy Association, National Health Law Program, Physicians for Social Responsibility, The Leukemia & Lymphoma Society, and Truth Initiative.
"It's much harder for agencies to exercise power without some power to interpret statues. This is big," wrote Berkeley Law Professor Orin Kerr on X.
A New, Uncertain Landscape for Health Care
In the original Chevron case, the Court ruled that federal agencies had relevant expertise and should be given deference in resolving ambiguities that Congress had not spelled out in legislation.
In Relentless and Loper Bright, the plaintiffs argued that federal agencies overstepped their authority by issuing a rule that required commercial fishing vessels to pay for professional observers to monitor their catch.
In a statement after Friday's ruling, the Relentless plaintiffs' attorneys said that the decision "will recalibrate the balance of power between agencies and courts," and "make it harder for those agencies to adopt regulatory programs that exceed the authority conferred on them by Congress."
Some predicted chaos in the wake of the ruling.
"Overturning Chevron could invite legal challenges to any and all agency determinations of ambiguous statutes by any stakeholder, leaving individual courts with the impractical task of determining the 'correct' meaning of statutes without the benefit of requisite expertise, practical experience, or public engagement," wrote Sahil Agrawal, MD, PhD, Joseph S. Ross, MD, and Reshma Ramachandran, MD, in JAMA in an opinion piece in March that considered the ramifications of overturning Chevron.
"The spillover effects for medicine and public health, in turn, will be consequential," they wrote.
In an analysis published in April, the Kaiser Family Foundation noted many potential ramifications on patient and consumer protections in the health insurance market. For instance, courts could vacate current rules governing protections under the Affordable Care Act, including that health plans offer a range of free preventive health services, such as breast, cervical, colon, and lung cancer screening.
Congressional, White House Reaction
Many legal observers said the ruling will have the effect of requiring Congress to write ever-more dense and exacting legislation to prevent agencies from interpreting any gaps.
Some members of Congress welcomed the decision.
Senate Minority Leader Mitch McConnell (R-Kentucky) said in a statement, "The Constitution vests Congress with the sole authority to make law," adding, "the Supreme Court made it clear today that our system of government leaves no room for an unelected bureaucracy to co-opt this authority for itself.
In a post on X, Senate Majority Leader Chuck Schumer (D-New York) accused the Court of siding with "special interests and giant corporations." Added Schumer, "Their headlong rush to overturn 40 years of precedent and impose their own radical views is appalling."
White House Press Secretary Karine Jean-Pierre said in a statement that "While this decision undermines the ability of federal agencies to use their expertise as Congress intended to make government work for the people, the Biden-Harris Administration will not relent in our efforts to protect and serve every American."
Alicia Ault is a Saint Petersburg, Florida-based freelance journalist whose work has appeared in publications including JAMA and Smithsonian.com. You can find her on X @aliciaault.