Health policy experts are closely monitoring the 2024 courtroom. The justices are poised to consider new health care policies, such as Medicare's right to negotiate drug prices, and old health care policies, such as the Affordable Care Act's insurance provisions.
The impact of these decisions, some on political issues such as abortion bans and gender-affirming care, is particularly important in an election year.
Here are five legal battles that experts will be watching closely in the coming months.
1. High court could significantly restrict medical abortions
The U.S. Supreme Court is scheduled to hear oral arguments in March. case It involves the Hippocratic Medical Alliance, a group of anti-abortion doctors that challenges the availability of drugs routinely used in medical abortions. This will be the first abortion-related case the justices will hear since SCOTUS voted to overturn the constitutional right to abortion in 2022.
The court will consider whether the doctors have legal standing to challenge the FDA's approval of mifepristone, one of two drugs used to terminate pregnancies. Mifepristone has been FDA-approved and prescribed in doctors' offices and clinics for more than 20 years, but regulators have increased access to it dating back to 2016. Women can receive prescriptions through telemedicine appointments You can take the tablets at home any time during the first 10 weeks of pregnancy.
Medication-induced abortion is currently the cause. More than half of all abortions nationwide. With about 50% of states currently restricting access to abortion procedures, experts expect more women to take advantage of mifepristone. That's why the drug is under intense scrutiny from anti-abortion groups, they say.
Hippocratic Medical UnionFiled a lawsuit in 2022, argued that members should be able to challenge the use and approval of a drug because they may have to treat the drug's side effects.of FDA and major medical associations including the American College of Obstetricians and Gynecologists and the American Medical Association Counter. Alliance members point out that there is no need to prescribe the drug and that decades of research and real-world evidence show mifepristone is safe and effective. Of the approximately 6 million women who have taken this drug in the United States, less than 1% Complications have been reported.
A federal district court judge in Texas agreed with the alliance in 2023 (but changes to mifepristone access will be put on hold until the case is resolved by SCOTUS). The judgment of the court of first instance is first time The FDA's stamp of approval was revoked because the judge disagreed with the FDA's scientific findings.
The case has attracted the attention of doctors, patient advocates, drug companies, and state legislators who are concerned that this challenge to FDA authority could reverse FDA decisions regarding other drugs. “We're thrilled to be working with KFF,” said Laurie Sobel, associate director of women's health policy at KFF. He said medicines disliked by the religious right, such as PrEP, a preventive treatment to combat HIV infection, could be targeted. “It's definitely a target of the culture wars, just like medical abortion,” Sobel said. “But this is very effective and has been a game changer in terms of changing the HIV epidemic.”
2. State abortion restrictions come under new scrutiny
A second abortion hearing is scheduled at the Supreme Court in April. case —This tests whether a state's abortion ban should include exceptions, and if so, which exceptions to include.
In 2022, the Department of Justice sued the state of Idaho, alleging that its restrictive abortion ban violated long-standing federal law.Asking the hospital to stabilize the patient In medical emergencies.
today 14 states have implemented total bans and 11 others block this procedure at a certain point during pregnancy. For example, Idaho law allows abortion only if: save pregnant people's lives, or some other very narrow example.Doctors Violating Idaho Laws law You could lose your state medical license or be sent to prison.
Meanwhile, the federal government has announced that if a doctor in Idaho (or any health care provider in any state) fails to perform an abortion when the mother's health is at risk, the doctor or hospital will be fined. , threatens to potentially lose federal coverage for other medical services.of Centers for Medicare and Medicaid Services We are investigating the complaint and Already found facilities in Kansas and Missouri It was against the law to deny emergency abortion services to a woman whose water broke at 18 weeks pregnant and who was at risk of serious infection and death.
KFF's Laurie Sobel said this conflict between federal and state law leaves doctors unable to rely on their own medical judgment. “Doctors are consulting with the hospital's lawyers and asking, Okay, can we do this now? …Can we do this now?'
Sobel said states with very narrow exceptions are forcing doctors to ask themselves, “How close to death do I have to be to perform an abortion?”
A SCOTUS ruling in the Idaho case, expected this summer, could define a “health exception” to the nation's abortion ban. Alternatively, the court could decide to allow some states to continue, with only the exception of “mother's life.”
3. The religious right takes aim at the Affordable Care Act.
Since the Affordable Care Act was enacted in 2010, 2,000 trials attempted to challenge part of the law. As a recent attempt, Braidwood Management v Becerra, is currently before the Fifth Circuit Court of Appeals in New Orleans and is expected to proceed to the U.S. Supreme Court.
In this case, the Christian-owned business and six other plaintiffs argue that one of the ACA's most popular provisions is that nearly all insurance companies provide their members with free access to certain preventive care, including contraception and anti-HIV treatment. The company is objecting to the provision that it must be provided in Not just PrEP. specific vaccines And cancer screening.
Plaintiffs allege that federal requirements force them to pay for some medical products and services that violate their religious beliefs about sexuality. The case was decided in their favor in 2023, but changes to the law based on that decision have been put on hold pending an appeal.
zac baronIf Braidwood wins, the country will return to a pre-ACA era, warns the co-director of the Health Policy and Law Initiative at Georgetown Law School's O'Neill Institute.
“They want insurance companies and employers to be able to choose which of these benefits they cover and how much to charge,” Barron said.
Legal experts expect the case to ultimately be heard by the Supreme Court, making it the fourth ACA case to be heard by SCOTUS.
4. Parents file lawsuit over state ban on gender-affirming care for teenagers
at least 23 states In recent years, we have passed laws that limit or prohibit gender-affirming care for minors. Williams Institute at UCLA; Public policy groups focused on LGBTQ issues estimate that these bans would impact about 100,000 transgender teens.
Many parents and major medical associationsAmerican medical associations, including the American Academy of Pediatrics and the American Medical Association, say research supports the idea that gender-affirming surgeries and medications can benefit the mental health of transgender youth.
Families challenging the state's ban in court argue that the law is a form of sex discrimination and targets transgender people.
Federal judges in several states, including Arkansas and Idaho, agreed, saying that in those states doctors can treat other teenagers for a variety of medical reasons, including birth defects and certain medical conditions that affect the ovaries. He pointed out that he is allowed to prescribe the same hormones.
However, appellate courts with jurisdiction over Alabama, Kentucky, and Tennessee have ruled that because the laws prohibit care for both men and women, the ban on gender-affirming care in these states does not discriminate on the basis of sex. It was ruled that no.
of Tennessee familyAnd that US Department of Justice It asked the Supreme Court to file a lawsuit challenging Tennessee's ban. If the court upholds such a ban, he said. katie yer This could undermine other civil rights protections for transgender people, according to anti-discrimination law experts at Rutgers University.
“I think it’s very clear that we’re at a point where the courts are very involved in determining the constitutional rights of the transgender community,” Iyer said, adding that any decision in the case would be “clear to everyone. “It will be important in the future,” he added. The same goes for other recently enacted discriminatory laws targeting transgender people. ”
5. Big Pharma Challenges Medicare's Authority to Negotiate New Drugs
Medicare is scheduled to begin negotiations with drug companies on Thursday. Publish the initial price We offer 10 of the most expensive and commonly prescribed medications at low prices. These negotiations are part of the Centers for Medicare and Medicaid Services. New powers to ensure lower drug prices For 66 million older Americans.
Major manufacturers such as Merck, Novo Nordisk and AstraZeneca have been experimenting with the new program in recent months. Filing at least nine lawsuits.
Pharmaceutical companies say these negotiations are unprecedented and that the federal government is forcing them to accept lower prices. CMS countered that it had been setting prices for doctors, labs and hospitals for decades, and that drug companies could opt out of Medicare if they didn't like the prices.
The first ruling, by an Ohio judge appointed by President Trump, sided with the government. Other court decisions are still pending.
in george town zac barron The drug companies said their strategy was to divert the judge's attention from the details of the program and focus instead on whether federal bureaucrats were overreaching.
If Medicare ultimately follows through on that date, the new negotiated prices for these drugs would go into effect in 2026, followed by further negotiations for other drugs. Policy analysts say the negotiations could bring Medicare closer to crisis. $100 billion Over the next decade, it will also save individual patients a lot of money. On the other hand, if a judge sides with drug companies, the federal government and older Americans could be locked into stubbornly high prices.
A recent national poll by KFF shows that issues such as health care costs, the future of Medicare and Medicaid, and abortion rights are among the top issues. Top 10 things voters care about. A collision between politics and the legal system is on the verge. Some of the most controversial of these cases could be decided months before the November election.
This story is from the Health Policy Podcast trade offOf partners public media of side effects. Dan Gorenstein is Tradeoffs' editor-in-chief and Alex Olgin is the podcast's senior reporter and producer. this story February 1.
