U.S. Supreme Court building

Health Law Cases in the Upcoming Supreme Court Term

By Alexa Richardson

The next Supreme Court term is shaping up to include a number of critical cases that will impact health law. From insurance, the Affordable Care Act, abortion access, and mental health, the decisions made this term could have significant impacts on public health moving forward. Here are some of the key health law cases upcoming this term to keep an eye on:

June Medical Services, LLC v. Gee

In one of the most watched cases of the upcoming term, the Court will decide whether to uphold a Louisiana law requiring physicians who perform abortions to have admitting privileges at a hospital.  In Whole Woman’s Health v. Hellerstedt, decided in 2016, the Court struck down a similar law, finding that the restriction violated the Constitution by placing an “undue burden” on women’s right to access abortion. Now, in June Medical Services, the Fifth Circuit has upheld a nearly identical provision, and the Supreme Court will decide whether to affirm or reverse that decision. Chief Justice Roberts is likely to be the key vote in this case, as he cast the fifth vote to block enforcement of the Louisiana law awaiting the appeal. Should the Court now uphold a law requiring admitting privileges, the decision would profoundly weaken abortion protections under the “undue burden” standard. As a result, states would be able to enact more significant obstacles to abortion access.

Kahler v. Kansas

This case will determine whether the Eighth and Fourteenth Amendments permit a state to abolish the insanity defense. The case raises significant questions about mental illness, intent, and culpability. Traditionally, the insanity defense has served as an affirmative defense, such that even if the prosecution could prove all the elements of the crime, the defense of insanity could still allow for a not-guilty finding. The state of Kansas contends that the insanity defense is unnecessary, and can be accounted for by the intent or mens rea element of the crime. Under this framework, a mentally ill defendant could argue that they lacked the requisite criminal intent. However, defendants that had the intent, but, for example, were suffering from delusions at the time, could not argue a defense of insanity. If the Court finds that the Constitution prohibits denial of the insanity defense, doing so would establish a new constitutional doctrine with uncertain implications.

Maine Community Health Options v. United States, Moda Health Plan, Inc. v. United States, Land of Lincoln Mutual Health Insurance Co. v. United States

The Court will decide three consolidated cases to determine whether Congress must fulfill statutory obligations under the Affordable Care Act to pay insurance companies that lost money on health exchange marketplaces. The “risk corridors” statutory scheme sought to limit insurance companies’ gains or losses in the marketplaces by promising to pay companies for excess losses, and requiring companies to pay back any profits over a certain amount. However, Congress then instituted appropriations riders that prohibited Health and Human Services from making the payments. The companies allege a “bait-and-switch” scheme that denied them more than $12 billion in payments. In a 2-1 decision, the Federal Circuit Court of Appeals ruled in favor of the government, finding that the appropriations riders, in combination with legislative history, indicated a clear congressional intent to cap the payments to insurance companies at the amount received from the program.

For more background on these cases, we recommend SCOTUSblog’s case file on each:

Texas v. United States

Although not on the docket yet, this case out of the Fifth Circuit challenging the constitutionality of the Affordable Care Act is likely to make an appearance. The Supreme Court, in NFIB v. Sebelius (2012), ruled the individual mandate in the ACA to be constitutional because it falls under the federal government’s taxation power. In 2017, Congress amended the Act to make the tax penalty for violating the individual mandate zero dollars. Now, in Texas v. United States, plaintiffs claim the mandate is no longer a tax and therefore unconstitutional. More significantly, they urge that the individual mandate cannot be severed from the law, and that it renders the entire ACA invalid. During oral arguments in July, 2019, the Fifth Circuit panel appeared sympathetic to the plaintiffs’ arguments. Striking down the ACA would leave millions of Americans without health insurance and throw billions of dollars of federal health funds into limbo. Should the Fifth Circuit find the ACA unconstitutional, the issue will almost certainly come before the Supreme Court this term.

Alexa Richardson

Alexa Richardson

Alexa Richardson is a law student at Harvard Law School and a Certified Professional Midwife. Prior to coming to law school, Alexa cared for families as the Director of a private midwifery practice in Baltimore, and led successful efforts to license and regulate Certified Professional Midwives in Maryland in her roles as President of the Association of Independent Midwives of Maryland (AIMM) and Chair of the Direct-Entry Midwife Committee under the Board of Nursing. Her research interests center on pregnant and birthing people, with particular focus in expanding the legal rights and protections available to this population. At HLS, Alexa serves as an editor of the Harvard Law Review, and as a student attorney in the Prison Legal Assistance Project.

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