Q&A: A ‘seismic ruling,’ Chevron reversal takes policy decisions away from health experts

Key takeaways:

• The Supreme Court has overturned a decades-old interpretation of administrative law that could adversely affect health policy.
• As a result, patients in the community may be adversely affected, an expert said.

On June 28, the U.S. Supreme Court ruled 6-3 in Loper Bright Enterprises v. Raimondo, Secretary of Commerce to overturn a decades-old decision known as the “Chevron deference.”

According to background information from Cornell Law School, under the Chevron doctrine — nicknamed after the 1984 case Chevron U.S.A. Inc. v. Natural Resources Defense Council Inc. — courts could defer to an agency’s interpretation or answer regarding administrative legal issues “holding that such judicial deference is appropriate where the agency’s answer was not unreasonable, so long as Congress had not spoken directly to the precise issue at question.”

In the Supreme Court’s ruling, delivered by Chief Justice John G. Roberts, it held that the Administrative Procedure Act requires courts “to exercise their independent judgment when deciding whether an agency has acted within its statutory authority” and that courts cannot defer to an agency’s interpretation just because a statute is ambiguous.

In 2023, a group of democratic lawmakers led by Representative Pramila Jayapal reintroduced the “Stop Corporate Capture Act” (SCCA). Senator Elizabeth Warren led a group of senators to introduce the Senate version of this legislation that would protect and codify the Chevron doctrine following its termination, according to a press release.

SCCA would “[allow] expert agencies to conduct rulemaking in line with their reasonable interpretation of their authorizing statutes” while reforming the regulatory process, the release noted. However, this legislation would need to pass both chambers of Congress to become law.

Speaking to Healio, Rita K. Kuwahara, MD, MIH, a primary care internal medicine physician and Healio Primary Care Peer Perspective Board member, discussed the ruling’s implications for health policy, how it could affect primary care clinicians and more.

Healio: What is the Chevron decision?

Kuwahara: The Chevron deference doctrine meant that when members of Congress enacted legislation that did not explicitly state that they were delegating authority to a specific agency to address a specific issue, they could defer to an agency’s reasonable interpretation of a law or statute when implementing that law or statute.

Healio: What are the ruling’s implications for health policy?

Kuwahara: This is a seismic ruling because it potentially opens all federal rules to litigation. At its core, the current Supreme Court ruling to overturn the Chevron deference doctrine shifts the power of health policy decision-making to judges and lawyers rather than to health professionals and researchers with advanced degrees who are subject matter experts working at federal agencies.

What was happening before the recent Loper ruling is that subject matter experts working in the agencies — including physicians, scientists and other individuals with expert knowledge — were able to implement the laws as Congress enacted in the ways they thought were most reasonable. That is how a lot of the rulemaking process was happening and how policies have been shaped.

But now with this Supreme Court ruling, the Court is shifting [administrative] rulemaking on very complex issues from physicians, scientists and other subject matter experts working in our federal agencies to the judges in our courts, who do not have the specialized knowledge in these issue areas.

Healio: Can you provide an example of how this ruling could affect primary care providers and their patients?

Kuwahara: I’ll point to the example of the Dobbs Supreme Court decision, which is not related to Chevron in any way, but overturning Roe v. Wade basically shows what happens when the courts and judges make a decision that influences how physicians can practice medicine. These are decisions that should be made between a physician and their patient based on clinical guidelines, but that is just an example of what happens when the courts have the final say rather than physicians or subject matter experts in certain areas.

Healio: Do you have anything else to add?

Kuwahara: In the past, federal agencies have really leaned on physicians and subject matter experts to make the decisions, and these are often individuals who are most connected with the community or who have experience with all the technical issues that are happening at the ground level and understand some of the most effective policy solutions.

By taking the authority away from the subject matter experts at the agencies and giving the courts the final say on these issues, you could have policies that are less effective [and] may not address the root causes of some of the problems they are trying to solve. Subsequently, patients in the community will be adversely affected by policies that are less robust than they could have been or are less effective than intended.

References:

• Chevron deference. Available at: https://www.law.cornell.edu/wex/chevron_deference. Accessed July 31, 2024.
• H.R.1507 - Stop Corporate Capture Act. Available at: https://www.congress.gov/bill/118th-congress/house-bill/1507. Accessed Aug. 6, 2024.
• Loper Bright Enterprises, et al, v. Raimondo, Secretary of Commerce, et al. Available at: https://www.supremecourt.gov/opinions/23pdf/22-451_7m58.pdf. Accessed July 31, 2024.
• Warren leads senate response to end of Chevron doctrine. Available at: https://www.warren.senate.gov/newsroom/press-releases/warren-leads-senate-response-to-end-of-chevron-doctrine. Published July 23, 2024. Accessed July 26, 2024.