COURTS & HEALTH

Last week, the U.S. Supreme Court issued several final rulings that have significant impacts on public health. Below is a summary of some of the major decisions.

Idaho vs. U.S. – Access to Emergency Abortion Services

The Supreme Court ducked making any substantive merits decision on whether federal law – known as the Emergency Medical Treatment and Active Labor Act (EMTALA) – overrides state law that blocks access to emergency abortions. Under Idaho state law, abortion is legal only to prevent the death of the mother. Under EMTALA, hospital emergency rooms are required to provide abortions, when medically necessary, to provide stabilizing care and prevention of serious deterioration.

The Court restored the trial court’s order suspending the Idaho abortion law, reversing a prior decision by the Supreme Court. The Idaho law remains suspended pending the trial court’s decision on the merits in this case.

The ATS joined over 20 other medical professional organizations in an amicus brief urging the U.S. Supreme Court to preserve access to emergency abortion services in all states as required under EMTALA.

Loper Bright vs. Raimondo – Federal Regulatory Authority

The U.S. Supreme Court struck down an important legal precedent known as the Chevron Deference, which states that when legislation passed by Congress is unclear courts must defer to the federal agency to make reasonable interpretation of the federal law. The precedent gave significant authority to federal agencies to interpret and implement federal law through regulations. 

A significant share of federal regulations in public health, Medicare, and Medicaid rules, environment and occupational safety are based on the courts applying the Chevron Deference.

This week’s Supreme Court decision now gives federal courts significantly more authority to review, revise and block a wide range of federal regulations. 

The ATS joined health and public health organizations in an amicus brief urging the Supreme Court to preserve the Chevron Deference, noting that many essential public health and environmental regulatory protections rely on it.

The full impact of the Court’s decision remains unknown, pending future case-by-case litigation on the legality of individual federal regulations. Today’s decision will touch on nearly every federal regulation, potentially creating regulatory and legal chaos across the U.S. economy; many federal regulations in the clean air and climate space will come under additional legal challenge with the Chevron Deference struck down.

U.S. Supreme Court Blocks Implementation of the E.P.A. Good Neighbor Rule for Ozone Pollution

The Supreme Court issued an order blocking the Environmental Protection Agency from implementing the Good Neighbor Rule for ozone pollution. The E.P.A.’s Good Neighbor program requires states that emit ozone pollution and ozone precursor-pollutants that blow across state lines to take steps to reduce their emissions from power plants and other industrial sources. Interstate ozone pollution – or downwind pollution – is a major problem for eastern seaboard states who are on the receiving end of ozone pollution emitted from sources in the Midwest. Many eastern seaboard states cannot meet E.P.A. ozone standards unless upwind states take steps to reduce their ozone emissions.

The U.S. Supreme Court’s action is unusual in the court-issued stay of implementation, before the D.C. District Court has issued its ruling on the case and before the EPA rule takes effect in 2026. Typically, the Supreme Court does not weigh in on matters until a lower court has made an initial ruling. This is the third time in recent years that the Supreme Court has inserted its authority to block environmental regulations before lower courts have issued a ruling. 

ATS Submits Amicus Brief in Support of E.P.A.’s Good Neighbor Program

While the Supreme Court was issuing an injunction blocking the E.P.A. from moving forward with the Good Neighbor Rule, the D.C. District Circuit Court of Appeals was judging the merits of the case. The ATS joined other health and environmental groups in an amicus brief urging the court to rule in favor of the E.P.A.’s authority to reduce overall ozone and ozone precursor-emissions to prevent transport of ozone pollution over state lines. The brief submitted by the ATS summarized the well-documented and serious adverse health effects caused by exposure to ozone pollution and why controlling emissions that cross state lines is essential to protecting public health, especially patients with respiratory diseases.

"The science is clear. Ozone is bad for human health. It is also clear that the current standard is not protective of human health,” said Nick Nassikas, MD, member of the ATS Environmental Health Policy Committee. “This Supreme Court ruling is a step backwards in the fight to protect human lives from ozone pollution. We need to find more ways, not fewer ways, for the E.P.A. to reduce ozone pollution in the U.S. It's one of the many reasons why we submitted an amicus brief in support of the Good Neighbor Rule."

Fifth Circuit Court of Appeals Issues Ruling on ACA Preventative Benefits

Last Friday, the Fifth Circuit Court of Appeals issued a ruling in Braidwood vs. Becerra regarding the constitutionality of requiring insurance companies to provide, at no cost to the consumer, preventative health benefits recommended by the U.S. Preventative Health Services Taskforce, Centers for Disease Control and Prevention  Advisory Council on Immunization Practices, and Health Resources and Service Administration. In this case, the company Braidwood Management challenged in federal court the requirement that businesses provide health insurance to their employees that cover USPSTF-recommended preventative services. Braidwood took issue with providing HIV prevention services – specifically PREP. Braidwood claimed the benefit was in violation of their religious beliefs and that it is not constitutionally permissible for the federal government to delegate coverage decisions to the USPSTF. 

Originally, a lower court ruled in favor of Braidwood and instituted a nationwide injunction on coverage of USPSTF recommended benefits. The Fifth Circuit Court of Appeals ruled that USPSTF recommendations are in violation of the Appointments clause and therefore are not constitutional. However, in an important ruling, the appeals court lifted the lower court’s nationwide injunction so that the Fifth Circuit decision only applies to the parties in the Braidwood case. Thus, coverage of USPSTF recommendations remain fully in place for most Americans and will likely continue for the pendency of this case. The U.S. Supreme Court has recently expressed strong opposition to nationwide injunctions where courts’ jurisdiction is limited only to the parties involved in any given case.

The court ruled separately that coverage recommendations made by ACIP and HRSA can be appropriately ratified by the Secretary of Health and Human Services, thereby avoiding concerns with the appointments clause. However, the appeals court did not rule on whether the Secretary had in fact properly ratified ACIP and HRSA recommendations and remanded the case back to the lower court for its decision. The applicable ACIP and HRSA recommendations remain in place, pending the trial court’s future decision.

The ATS joined the American Medical Association and several other medical organizations in an amicus brief urging the court to preserve the preventative health services under the Affordable Care Act. The ATS will continue to monitor this case as it moves through the courts.

BUDGET

House LHHS Bill Cuts C.D.C. Funding, Blocks Public Health Priorities

This week, the House Appropriations Committee released its draft FY25 Labor, Health and Human Services and Education bill. The bill provides federal funding for the public health service and many other federal agencies. The bill reduces overall spending by 4 percent compared to FY24 spending and cuts C.D.C. by 22 percent, including to cuts to tobacco control, climate, TB control, gun violence prevention, and occupational health programs.

The bill provides a small increase in NIH funding and proposes to restructure NIH by reducing the number of Institutes from 27 to 15. 

The bill also includes several policy riders on abortion, health equity, tobacco control, climate change, and the environment to block many Biden Administration policies. Of particular concern to the ATS is a policy rider that prevents the Mine Safety and Health Administration from implementing a final rule to reduce miner’s exposure to silica dust. 

The bill was passed out of subcommittee along party lines and drew sharp criticism from Democratic members. The bill now moves to the full Appropriations Committee and is expected to be considered in early July.