Overturn Of the Chevron Doctrine And The Impact on Health Care

 

The overturn of the Chevron Doctrine is the worst Supreme Court decision yet, making effective administration impossible for federal agencies which are charged with regulating public safety laws for air pollution, water quality, food, and healthcare safety. The Chevron Doctrine gave administrative power to federal regulators to make rulings to run their agencies. The Chevron Ruling is cited in 17,000 lower court and 70 previous Supreme Court Decisions (Nielsen, 2024). This includes scientists who decide how to assess pollution damages, water quality, air quality, and other environmental protections to keep the public safe. This also includes medical research and other experts who decide which drugs are safe and should receive Food and Drug Administration (FDA) approval. Further the FDA, oversees health standards for food, and those will become subject to myriad lawsuits, and incompetent rulings in smaller courts by nonexperts. Even worse than that, medical devices, cardiac implants, various surgical treatments will proliferate and be brought to the public based on specious science due to diminished oversite. We all know there is enormous fraud in healthcare, anti-trust activity in big agriculture, and serious conflicts of interest with the oil and gas industry. These industries will now have an outsized influence on the air you breath, the water you drink, whether the soil is contaminated where you live, the safety of the food you eat, and the validity of new drug and medical devices. Huge corporations in pharmaceuticals, oil and gas, and agriculture will now be able to power their way through local, state, and federal courts to create wealth at the expense of public health and safety. And thanks to the Citizens United Decision, corporations are treated as voters.

Ramifications for Health Care

 For the purposes of this analysis, I will focus just on the healthcare ramifications of the overturn of Chevron. Briefly, here are major programs whose existence will be threatened under the new wild west environment with the high court:

  Government’s Ability to Promote Innovation Will Be Hindered-Centers for Medicare and Medicaid demonstration projects, which are incentivized voluntary clinical efforts to improve health care will be hindered and possibly stop.

 Millions of working-class people may lose their health care-Eligibility standards for Medicaid may be changed for the Affordable Care Act expansion, of which all but eight states have adopted, which provides millions of people with subsidized medical insurance.

 Patient Safety is At Risk-If there is limited federal regulation then states can decide how far they wish to go in minimizing staffing ratios at nursing homes and other health care facilities thus endangering patient health. 

Ability to Assure Acceptable Health Care Standards is At Risk-Government payments from Medicare and Medicaid must currently meet standards of care including; staffing ratios, accreditation, and quality of care and the enforcement of these critical provisions are now in question.

Fraud Prevention-The Justice Department has its own division for health care fraud which reviews government billings and prosecutes fraud. In 2023, it charged 193 clinicians with 2.75 billion of fraudulent claims. (United States Department of Justice Press Release, 2024) The federal Department of Justice is the only authority powerful enough to go after abuses by pharmaceutical corporations, insurance companies, medical device manufacturers, mega hospital groups, and third-party administrators like pharmaceutical benefit managers. Who will look out for the American people if their ability to regulate and bring fraud charges is muted?

 Children’s Health Insurance Coverage-Families receive insurance subsidies based on their income according to a federal formula and this will be challenged.

 Increased Cost of Public Program Administration-Slower approval process and more court actions for any government regulation which will make administration by public agencies more expensive not less.

Government agencies are created to serve the people and none could be closer than Health & Human Services (HHS). Briefly these are things HHS does for us:

 1. Finances much of the medical research in the United States through the National Institutes of Health, awarding nearly two trillion dollars in grants 

 2. Creates health care quality standards through the Agency for Healthcare Research and Quality (AHRQ)

 3. Oversees vaccine production and supply as well as pandemic controls for public safety

4.  Is the repository for the National Library of Medicine, essential for medical research and policymaking

5,  Establishes health care treatment and reimbursement standards through the Centers for Medicare and Medicaid

6. Targets specific health interventions like treatment for opioid addiction and suicide prevention efforts

 Health and Human Services used its authority for public health during the Covid-19 pandemic when it was able to rapidly coordinate with the pharmaceutical industry to create effective vaccines to avert more loss of lives. The Centers for Medicare & Medicaid (CMS) deployed its authority for public good when the agency refused to approve reimbursement for aducanumab, an unproven treatment for Alzheimer’s. The approval for this drug application was later repealed by the Food and Drug Administration (FDA), because of a public outcry led by the Right Care Alliance and the scientific community. (Winter, 2022) This is an example of effective administration which saved the public millions from an unproven and specious drug application. The independent decision-making authority of this agency, separate from the FDA is essential for public health and safety. All these actions are for the health and welfare of the people of the United States.

 Given the spate of bad news in 2024, the sweeping aside of the Chevron doctrine will do the most lasting damage for hundreds of years. We are basically watching the collapse of this once great nation, Putin and Xi Jinping must be laughing their buts off.

 And this is the healthpolicymaven signing off, encouraging you not to sign blanket releases when you have medical procedures, do specify that for which you consent and which you decline. This column is published without remuneration from any healthcare entity and the opinions expressed here are those of health policy analyst and journalist, Roberta Winter, whose guidebook to the U.S. healthcare system was published in 2013. https://rowman.com/ISBN/9781442222977/Unraveling-U.S.-Health-Care-A-Personal-Guide 

References

Melissa Quinn, J. R. (2024, 24 22). What is Project 25-What To Know About the Conservative Blueprint For A Second Trump Administration. Retrieved 9 2, 2024, from CBS News: https://www.cbsnews.com/news/what-is-project-2025-trump-conservative-blueprint-heritage-foundation/

Nielsen, M. (2024, July 12). Impact of Supreme Court Decision on Health Policy. Retrieved September 3, 2024, from Milbank blog.org: https://www.milbank.org/2024/07/impact-of-supreme-court-chevron-decision-on-health-policy/#:~:text=In%20addition%20to%20the%20numerous,health)%2C%20and%20patients'%20data

United States Department of Justice Press Release. (2024, June 27). National Health Care Fraud Enforcement Action Results in 193 Defendants Charged and Over $2.75 Billion in False Claims. Retrieved September 3, 2024, from Justice.gov: https://www.justice.gov/opa/pr/national-health-care-fraud-enforcement-action-results-193-defendants-charged-and-over-275-0

Winter, R. E. (2022, January 27). https://healthpolicymaven.blogspot.com/2022/01/high-cost-of-single-unproven-drug.html. Retrieved from Straight Talk On Healthcare. healthpolicymaven.blogspot.com: https://healthpolicymaven.blogspot.com/2022/01/high-cost-of-single-unproven-drug.html