Illustration: Sarah Grillo/Axios
A closely watched case at the Supreme Court could put Congress on the hook for spelling out Medicare payment policies, responses to scientific advances and myriad other federal health initiatives.
Why it matters: Justices will rule within weeks whether to overturn the decades-old legal doctrine called the "Chevron deference" that gives executive branch agencies discretion to interpret unclear laws or ones subject to more than one interpretation.
- Dialing back federal health agencies' expertise could result in widespread confusion and make Congress a kind of super arbiter on technical matters when it's struggled to just keep the government funded and has punted on reauthorizing major programs.
- "It seems like there could be a very significant backlog," said Michelle Long, a senior policy analyst for the patient and consumer protections program at KFF.
Between the lines: Chevron has been a target of conservatives who support broad deregulatory efforts.
- As we've reported, the case involves a challenge to fishing regulations, but health experts say a rollback could trigger a wave of litigation and hinder the administration of public insurance programs like Medicare and Medicaid.
- That's where Congress then may have to step up, though lawmakers are likely woefully unprepared for what that could mean, the experts said.
Lawmakers may have much more of a say on Medicare payments to health providers, what constitutes a public health emergency, and regulation of preventive health services and drug approvals.
- Chevron came into play in deciding the duration of short-term health plans, a Trump administration initiative that was challenged and then upheld on the basis of Chevron.
- Down the road, Congress may also have to sort out rules for how AI and automated processes are used to make coverage decisions in employer-sponsored health plans regulated by ERISA.
What they're saying: Some of the biggest challenges Congress will face are making legislative language much more specific, since now a lot of bills leave a great deal of latitude to agencies.
- "They will have to be more explicit in how they craft and the language that they use for legislation," said Long. "Not every law that Congress writes is very specific on every single detail, the idea being that federal agencies will kind of fill in the gaps based on the knowledge, expertise and data that they have."
- "If you look at the resources and staffing Congress has, personal offices are not particularly big, committee staffs are fairly small," said Zach Baron, director of the health policy and law initiative at the O'Neill Institute at Georgetown University.
- "In a world in which Congress is going to need to potentially be more hands-on, it's going to be more and more important to have built-in talented staff to work on this," said Baron, who was formerly a Ways and Means staffer.
That's also not to mention the dearth of health policy-minded legislators, particularly doctors, who are retiring from Congress at the end of this year.
Yes, but: Even if the Supreme Court does choose to overturn or narrow Chevron, agencies will still have some authority.
- There are other types of legal frameworks that could be used to defend agency authority.
- And if regulations aren't challenged, then they will continue to operate as-is without issue.
