Recent Supreme Court Rulings and Family Medicine

Transcript

David Tully: In this episode, I'm pleased to be joined again by Shannon Rohn Deere of Leavitt Partnersa consultant the Academy works with to track the US Supreme Court cases that could affect family physicians.

Welcome to Fighting for Family Medicine. I'm David Tully, vice president of Government Relations, and a member of the AAFP's advocacy team.

The United States Supreme Court closed its 2025 session with some decisions that will have an impact on primary care practices and the patients that are served the AAFP monitored these cases with the help of Levitt Partners, a Washington DC based consulting firm specializing in healthcare policy.

To talk about how the courts factor into the Academy's advocacy and about the possible fallout from these most recent rulings. I'm pleased to be here today with Shannon Rohn Deere of Leavitt Partners. Shannon, thanks for being here and welcome back to the podcast. Thanks so much for having me back. It's a pleasure working with you and your team, and I'm looking forward to discussing a number of rulings that will have, I think, really important impacts on family, physicians and health policy today.

Shannon Rohn Deere: Great. I'm really looking forward to our conversation today as we get into the issues.

DT: I wanted to note first that Shannon is a licensed attorney, but Leavitt Partners is not a law firm, and Shannon does not provide the academy with legal advice. Leavitt Partners’ team tracks legal updates for the AAFP to help us evaluate policy impacts on family physicians.With that disclaimer provided, let's dive in.

Medina v. Planned Parenthood: implications for Medicaid

DT: Again, this term, the court heard a case that rendered a decision that cuts to the heart of the Academy's advocacy to protect the physician patient relationship. I'm talking about Medina versus Planned Parenthood, which will limit Medicaid enrollees in South Carolina and in other states that exclude Planned Parenthood going forward from using that coverage to obtain preventive services, including contraceptive care, STI, treatment and cancer screenings at Planned Parenthood Clinics.

Family physicians, of course, deliver reproductive health services at a broad scale, and now, especially in states with already restrictive policies, could face heightened barriers to the Medicaid participants. Shannon, can you talk about how we got here and what you think the immediate impacts will be of this decision?

SRD: Sure. I think a lot to explore here, David. So in the case at hand, the Supreme Court was asked to evaluate whether or not Medicaid enrollees can bring lawsuits to challenge state restrictions on providers. In this case, South Carolina's restrictions on Planned Parenthood, even where they're providing non-reproductive-related services.

The Medicaid statute has a provision which allows for enrollees to receive care from any provider qualified willing to perform the services. The question before the court was whether this part of the statute creates a private right of action under a civil rights law, which would allow individual enrollees to sue the state to enforce their right to choose a particular provider in Medicaid.

Medicaid enrollees’ choice of clinician

The court, in a 6-3 decision, found that this part of the law does not establish an individual right to bring a lawsuit to enforce individual constitutional and legal rights related to choosing a provider in Medicaid. Justice Gorsuch relied on precedent and other statutes that do create this type of right to conclude that this provision does not allow for individual lawsuits.

Most notably, he said that this part of the law doesn't explicitly use the term right when describing provider choice, and the enrollee’s ability to choose a provider. To enforce this requirement, the court notes that it is the federal government, through its spending power and ability to withhold funds from states that don't comply, that would compel states to provide greater choice of different qualified providers.

The dissenting justices disagreed, saying that Congress had intended for this provision to create an enrollee’s right to choose a provider, and that the best way to enforce it is for enrollees to be able to challenge the state through lawsuits. The court's opinion makes clear that states have a right to determine what makes a provider qualified to participate in Medicaid and only where they are significantly out of compliance.

Will the federal government opt to withhold funds, if at all? The court also leaves the door open for providers like Planned Parenthood to go through an administrative process to challenge their exclusion from the program. However, that process goes up through the state itself and may eventually land with the Supreme Court.

Concerns for family physicians include Medicaid access gaps

Practically speaking, this case is a win for states looking to restrict access to particular providers, and the decision underscores the state's discretion in managing providers that participate in Medicaid. For family physicians, it raises concerns about what states might use as justification for disqualifying providers, whether it be the physician's involvement in rendering reproductive services, or providing other treatments or vaccines the state wants to restrict when thinking about what happens next.

A lot will depend on the state's Medicaid program. Its leadership at the State House and its reasoning for restricting the provider. While states could theoretically try a number of different restrictions. The reality is that there are still a lot of gaps for enrollees accessing providers in Medicaid and states rely on many providers, including many family physicians, willing to serve the Medicaid population in the short term.

With the passage of H.R. 1, Medicaid payment is now restricted to Plan Parenthood for one year, and I think we can expect to see additional states restrict participation in their Medicaid programs for Planned Parenthood after that point as well. But as I said, I think there's a lot of uncertainty as to how this decision will affect other providers in Medicaid.

U.S. v. Skrmetti: government interference in the physician-patient relationship

DT: US v. Skrmetti is another case involving possible care restrictions for family physicians and ultimately the government's ability to interfere with how physicians choose to deliver that healthcare. Can you talk about what the implications are here for family physicians in this case?

SRD: Sure. This is another case that fits in a theme this term with the court's decisions related to flexibility granted to states to regulate medical care,in this case, directly regulating providers and specific treatments. This case concerns a Tennessee law, which prohibits providers from furnishing certain types of gender-related care to minors. Several minors, their parents and a physician challenged the law, arguing that it was discriminatory, violating the equal-protection clause of the 14th Amendment.

Court says states have significant flexibility to govern medical practice

Now, hopefully this doesn't sound too much like a constitutional law class, but I do want to provide some brief, important background here, which affects how the court decided and the standards that it used. To decide whether or not the law violated the Constitution, the court first needed to determine what level of scrutiny to put the Tennessee law under.

When laws are designed to treat people differently, the court requires varying degrees of reasoning to evaluate the law. If it treats people differently based on their race, for example, it gets the highest level of scrutiny from the Supreme Court. Laws that treat individuals differently based on sex typically receive an intermediate level of scrutiny —meaning that the law must serve an important governmental interest, and the means chosen are substantially related to serving that interest. Laws that treat other classes differently by age, for example, are typically reviewed by a rational-basis standard. For that type of law, a state only needs to prove that the law is rationally related to a legitimate government interest.

These levels of scrutiny matter a lot because the government is very likely to overcome challenges where the rational-basis standard is used Here, the plaintiffs challenging the state law wanted the court to use intermediate scrutiny, arguing that this law discriminated based on sex. The court said that it was not an intermediate scrutiny since the state law treats biological males and biological females the same throughout the law and restricts only based on age and by diagnosis use to prompt the treatment.

Importantly, the court asserted definitively that states have significant flexibility to pass laws governing medical practice, in particular, where they determine there is scientific uncertainty. So here they use the rational-basis standard, finding that the Tennessee law was related to a legitimate government interest in addressing scientific uncertainty about this type of medical treatment.

The court noted a number of reports from other countries, as well as shifts in standards related to gender care and its decision to uphold the Tennessee law in terms of impact. This decision is important because numerous other states have similar laws preventing physicians from providing this type of medical care, and this decision empowers states to keep and, in some cases, expand those restrictions.

For this type of care, the decision is increasingly being more closely regulated at the state and federal level, as we have seen so far in the Trump administration. One area I would say would be important to watch as more litigation over these types of laws unfolds in the coming years is related to parental rights in deciding what types of treatments their children can receive.

If there's a good amount of precedent that allows for a lot of parental authority in these types of decisions, and it'll be interesting to see how the courts approach this issue in the coming terms.

Kennedy vs. Braidwood: Affordable Care Act upheld, but further challenges likely

DT: So, this term’s docket also had yet another challenge to the Affordable Care Act in the case of Kennedy versus Braidwood.In the end, the court upheld the activities of the US Preventive Services task force. That's probably not the last word on the ACA preventive services and cost sharing. So I'm wondering if you could talk a little bit more about this case and kind of what the outcome, or maybe what the long-term implications will be for preventive health and primary care.

SRD: Sure. So, as you note, this case concerns the US Preventive Services Task Force and their recommendations, which grade certain preventative health services that Americans can receive. This was probably the most anticipated health care case this term, and it's only on one portion of the case that the Supreme Court was weighing in.

So we can definitely expect to see more here in the coming terms and at the lower courts. Prior to the Affordable Care Act, the task force's recommendations were advisory. But the ACA then required most health plans to cover task-force-recommended services that receive an A or B rating. Plaintiffs in this case challenged the ACA, in particular the requirement for covering task-force-recommended services on several grounds, including religious objections to certain services recommended by the task force and, for purposes of this part of the lawsuit, the structure of the task force itself. The plaintiffs argued that the task force was not constitutional because it violates the appointments clause of the Constitution. They argued that for the task force to operate as a truly independent adviser, the members must act like what are called principal officers, which are confirmed by the Senate.

However, task force members are not confirmed in that way and are instead appointed by the secretary of Health and Human Services. The government, under both the Biden and subsequently the Trump administration, argued that the task force is made up of what are called inferior officers. The court agreed with the government finding that the task force is made up of inferior officers for two key reasons.

First, the HHS secretary can appoint and remove task force members at will. Second, the task force's recommendations are not the final word on what health plans must do. They note that the secretary can review and block certain recommendations in the year before they go into effect, through additional regulatory authority and ability to do rulemaking and further delay recommendations from going into effect.

This decision is important for a few key reasons. David, as you note, the court is upholding the structure of preventive services coverage that was designed in the ACA, including the authority of the task force. So nothing on its face is changing about the task force or how it does recommendations and what the effect of those recommendations is.

However, since the task force is under the control of HHS, we could expect to see changes as a result of Secretary Kennedy. We've already seen his actions related to the advisory committee on immunization practices, or ACIP, where he removed all existing members and made changes to the vaccine schedule without their input.

It remains to be seen if you will undertake similar actions with regard to the task force. But he did postpone a recently scheduled task force convening and has argued that he may have authority to veto or revisit old recommendations and have more direct input into what the task force is doing. So all of that remains to be seen. And and I will note what happens next is particularly important for consumers and physicians to watch closely.

Task force recommendations under the ACA have to be covered without cost sharing, so it really affects whether or not certain services will be available to consumers free of charge, and task force recommendations cover a wide range of areas that are important to preventive care in public health, as a flavor of what the task force is involved in.

Last month, they made recommendations for screenings related to intimate partner violence. On their upcoming docket are things like tobacco cessation, risk assessment for hereditary cancer, autism spectrum disorder screening, vision screening in children, HIV screening and behavioral counseling for weight loss to prevent cardiovascular disease.So, a number of areas that your members are heavily involved in. There's definitely more to come here as courts weigh in on some of the other questions in the Braidwood case, and certainly more to watch when it comes to how Secretary Kennedy interacts with the task force.

Upcoming Supreme Court cases to watch

DT: So with the end of one Supreme Court session prepares for the next Supreme Court session, which will kick off in October. Based on some of the initial reports that you've seen, can you talk a little bit about some of the cases that are on the horizon that we will be closely tracking over the next year as it relates to primary care and family medicine?

SRD: Sure. So, I think there are a few different categories of areas that we'll want to watch. As I just mentioned, Secretary Kennedy's actions are receiving a lot of attention in the courts, including his actions related to laying off a number of employees at HHS, his actions related to the vaccine schedule and ACIP, and we would expect that litigation to continue and potentially advance its way to the Supreme Court in some cases.

In particular, it already has advanced to the Supreme Court on the question of whether or not HHS could proceed with those layoffs of a number of employees. In terms of other areas that we follow for the Academy, you know, cases related to FDA's authority, including in care-restricting areas, non-compete agreements, gun laws.

And administrative cases that could have a broader impact on health care are all areas that we continue to watch and where we've seen federal litigation that may make its way to the Supreme Court next term. I do want to flag, too, you know, there's one decision this term that wasn't health care, per se, but will have wide-ranging impacts in terms of how it affects health care cases in the future.

The Supreme Court, in the case Trump v CASA, sharply limited the ability for lower courts to issue universal injunctions, which have been increasingly used to block administrative actions and laws. While litigation on the merits is ongoing, the court found that there can be an injunction for the individual plaintiffs to provide them relief, but not the universal injunctions that the court has seen increasingly over time.

So this will have a really important impact on the scope of litigation, especially in its early stages, and potentially directly impact a number of the health care cases that we'll see. This is probably obvious to folks, but I would also say that care restrictions that impact the physician-patient relationship will continue to be a significant focus for the courts, especially given the landscape of various state laws and continued interest in both limiting the participation of certain providers, as well as prohibiting specific treatments.

So we saw a couple of really important cases this term. I expect that we'll see more into the future and, and a lot more for us to talk about there next year. And David, as you'll note, we'll be closely watching these trends and we'll report back with the most important changes impacting your members.

DT: Sounds great. Shannon, I can't thank you enough for your time. It was great to have you back on the podcast, and I do look forward to continuing our partnership on all things legal tracking, as well as some of the other policy areas that we have the privilege of partnering with you all on. So thank you again for your time.

Thank you. If you've enjoyed today's episode, let us know by dropping a line to AAFP news at AAFP . Be sure to share the episode with your followers on social media and tag the AAFP. We will talk to you soon.