Supreme Court Health Law Cases 2014 Review
Supreme Court (and More)
Health Law Cases 2014
Marshall Kapp, J.D., M.P.H.
FSU Center for Innovative
Collaboration in Medicine and Law
Burwell v. Hobby Lobby Stores
Conestoga Wood Specialties Corp. v. Burwell
(June 30, 2014)
•
Introduction
–
Three forms of ownership
•
Govt.
•
Private not-for-profit/community/voluntary
–
Sectarian or Secular
•
Private for-profit/proprietary (secular)
–
Public (anyone can buy stock/equity)
–
Closely-held (usually family) (90% in US)
•
Affordable Care Act (ACA)
–
Large employer health insurance mandate (Play or
pay)
–
Essential benefits package, including preventive
services (defined by IoM to include all 20
contraceptive agents approved by FDA). Hobby
Lobby objected to 4 agents.
–
Non-profit religious organizations can apply for
“accommodation” to shift costs to the
organization’s insurer
•
First Amendment free exercise of religion:
Not
the basis for this challenge
•
Challenge based on
Religious Freedom
Restoration Act of 1993 (RFRA)
–
Congress’ response to 1990 decision that, even if
a law substantially burdened religion, OK if it was
not intended to burden religion (was “neutral”),
applied without regard to religious beliefs and
practices (“generally applicable”), and was
rationally related
to a
legitimate
govt interest.
•
RFRA applies when a federal law
“substantially” burdens a person’s exercise of
religion,
even
if law is neutral and generally
applicable.
–
Law must further a
compelling
govt interest using
the
least restrictive/least intrusive
means
available.
•
Majority (5-4)
–
Closely held, for-profit corporation is a “person”
under RFRA.
•
Such a “person” can have religious beliefs.
–
ACA contraceptive requirement substantially
burdens a religious belief ($475 M/yr penalty).
–
Issue about scientific validity of Hobby Lobby’s
religious beliefs
»
Mandate advances a compelling govt interest
•
But
there are less restrictive/intrusive
means to achieve the same result.
Implications
•
For future RFRA challenges to legal
requirements on closely-held corporations?
–
Case-by-case analysis of:
•
Substantial burden on religious exercise
•
Compelling govt interest
•
Least restrictive means to achieve the
compelling govt interest
•
For health care?
–
Congress can repeal or amend RFRA, to make
closely-held, for-profit corps non-persons.
•
July 9, Protect Women’s Health From Corporate
Interference Act, S. 2578
•
Classic “bootstraps” solution
–
Congress can pay for non-covered contraception
itself.
–
Congress can provide an “accommodation” for
closely-held, non-profit corps just like religious
non-profits
•
Assuming such accommodation is sufficient for RFRA
(
But see Wheaton College
case)
–
Individuals can purchase contraceptives personally
–
Congress can rethink employer-based coverage
altogether.
Wheaton College v. Burwell, 573 U.S.
–
(July 3, 2014)
•
Wheaton=private, non-profit religious entity
•
ACA: Religious entity must play (provide
essential services, including all FDA-approved
forms of contraception) or pay penalty, but
–
May obtain an exemption by filing religious
objection on EBSA Form 700. Filing triggers right
of employee to have
insurer
pay for whatever the
employer won’t cover.
–
Wheaton objected to filing the form and triggering
an immoral consequence.
•
Procedural Posture of the case
–
Wheaton’s challenge to the religious entity
accommodation under RFRA is pending in the
courts
–
Wheaton requested a
temporary injunction
excusing it from filing EBSO Form 700
while its
challenge is pending
.
•
Irreparable injury
•
Likely to win on the merits
•
No other way to protect rights
–
Supreme Court granted the temporary injunction
–
Significance:
•
Not
a ruling on the merits of the case (
not
a permanent
injunction)
•
No precedential value for other cases
•
But
, hints that court may find the religious entity
accommodation invalid (
not
the least intrusive way for
the govt. to accomplish a compelling public interest in
light of the substantial burden to religion placed on the
employer)
•
http://www.supremecourt.gov/opinions/13pd
f/13a1284_ap6c.pdf
McCullen v. Coakley
(June 26, 2014)
•
2000 Mass. statute established 18-ft radius
(“bubble zone”) around entrances and
driveways of facilities providing abortions.
Within the bubble, nobody, without consent,
could approach within 6 feet of another
person for the purpose of protesting,
leafleting, counseling, or education.
•
Challenged on 1
st
Amendment freedom of
speech grounds
•
Unanimous decision invalidating statute
–
5 justices: Statute burdened
all
speech (content
and viewpoint-neutral) without being narrowly
tailored to serve a significant govt interest
(ensuring public safety). Law went too far, could
have served govt interest less intrusively.
–
Leaves door open to less intrusive means to
ensure public safety (e.g., floating bubble zone
around women)
–
4 justices concurred: Statute was aimed at
specific content and viewpoints, therefore could
never
be permissible, even if less intrusive.
Halbig v. Burwell, D.C. Cir., No. 14-
5018, July 22, 2014
•
Challenge to IRS regulation on tax credits
(subsidies) for people buying health insurance
through exchanges
•
Court invalidated regulation
–
ACA (statute) created tax credits for people buying
insurance on
state
exchanges.
–
Regulation authorized tax credits for people
buying insurance on
state or federal
exchanges.
–
Regulation must be consistent with authorizing
statute: Political accountability
King v. Burwell, 4
th
Cir., No. 14-1158,
July 22, 2014
•
Same issue, opposite result
•
Language of the law is “ambiguous and
subject and multiple interpretations” and “We
uphold the rule as a permissible exercise of
the agency’s discretion.”
The Marshall Kapp, J.D., M.P.H. review of Supreme Court health law cases in 2014 focuses on Burwell v. Hobby Lobby Stores and Conestoga Wood. The cases involved challenges to the Affordable Care Act's contraceptive requirement based on the Religious Freedom Restoration Act of 1993. The court ruled in favor of closely held, for-profit corporations having religious beliefs under RFRA, requiring a compelling government interest for mandates. Implications for future RFRA challenges are discussed, highlighting the significance of religious beliefs in the context of healthcare laws.
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Presentation Transcript
Supreme Court (and More) Health Law Cases 2014 Marshall Kapp, J.D., M.P.H. FSU Center for Innovative Collaboration in Medicine and Law
Burwell v. Hobby Lobby Stores Conestoga Wood Specialties Corp. v. Burwell (June 30, 2014) Introduction Three forms of ownership Govt. Private not-for-profit/community/voluntary Sectarian or Secular Private for-profit/proprietary (secular) Public (anyone can buy stock/equity) Closely-held (usually family) (90% in US)
Affordable Care Act (ACA) Large employer health insurance mandate (Play or pay) Essential benefits package, including preventive services (defined by IoM to include all 20 contraceptive agents approved by FDA). Hobby Lobby objected to 4 agents. Non-profit religious organizations can apply for accommodation to shift costs to the organization s insurer
First Amendment free exercise of religion: Not the basis for this challenge Challenge based on Religious Freedom Restoration Act of 1993 (RFRA) Congress response to 1990 decision that, even if a law substantially burdened religion, OK if it was not intended to burden religion (was neutral ), applied without regard to religious beliefs and practices ( generally applicable ), and was rationally related to a legitimate govt interest.
RFRA applies when a federal law substantially burdens a person s exercise of religion, even if law is neutral and generally applicable. Law must further a compelling govt interest using the least restrictive/least intrusive means available.
Majority (5-4) Closely held, for-profit corporation is a person under RFRA. Such a person can have religious beliefs. ACA contraceptive requirement substantially burdens a religious belief ($475 M/yr penalty). Issue about scientific validity of Hobby Lobby s religious beliefs Mandate advances a compelling govt interest But there are less restrictive/intrusive means to achieve the same result.
Implications For future RFRA challenges to legal requirements on closely-held corporations? Case-by-case analysis of: Substantial burden on religious exercise Compelling govt interest Least restrictive means to achieve the compelling govt interest
For health care? Congress can repeal or amend RFRA, to make closely-held, for-profit corps non-persons. July 9, Protect Women s Health From Corporate Interference Act, S. 2578 Classic bootstraps solution Congress can pay for non-covered contraception itself.
Congress can provide an accommodation for closely-held, non-profit corps just like religious non-profits Assuming such accommodation is sufficient for RFRA (But see Wheaton College case) Individuals can purchase contraceptives personally Congress can rethink employer-based coverage altogether.
Wheaton College v. Burwell, 573 U.S. (July 3, 2014) Wheaton=private, non-profit religious entity ACA: Religious entity must play (provide essential services, including all FDA-approved forms of contraception) or pay penalty, but May obtain an exemption by filing religious objection on EBSA Form 700. Filing triggers right of employee to have insurer pay for whatever the employer won t cover. Wheaton objected to filing the form and triggering an immoral consequence.
Procedural Posture of the case Wheaton s challenge to the religious entity accommodation under RFRA is pending in the courts Wheaton requested a temporary injunction excusing it from filing EBSO Form 700 while its challenge is pending. Irreparable injury Likely to win on the merits No other way to protect rights
Supreme Court granted the temporary injunction Significance: Not a ruling on the merits of the case (not a permanent injunction) No precedential value for other cases But, hints that court may find the religious entity accommodation invalid (not the least intrusive way for the govt. to accomplish a compelling public interest in light of the substantial burden to religion placed on the employer)
http://www.supremecourt.gov/opinions/13pd f/13a1284_ap6c.pdf
McCullen v. Coakley (June 26, 2014) 2000 Mass. statute established 18-ft radius ( bubble zone ) around entrances and driveways of facilities providing abortions. Within the bubble, nobody, without consent, could approach within 6 feet of another person for the purpose of protesting, leafleting, counseling, or education.
Challenged on 1stAmendment freedom of speech grounds Unanimous decision invalidating statute 5 justices: Statute burdened all speech (content and viewpoint-neutral) without being narrowly tailored to serve a significant govt interest (ensuring public safety). Law went too far, could have served govt interest less intrusively.
Leaves door open to less intrusive means to ensure public safety (e.g., floating bubble zone around women)
4 justices concurred: Statute was aimed at specific content and viewpoints, therefore could never be permissible, even if less intrusive.
Halbig v. Burwell, D.C. Cir., No. 14- 5018, July 22, 2014 Challenge to IRS regulation on tax credits (subsidies) for people buying health insurance through exchanges Court invalidated regulation ACA (statute) created tax credits for people buying insurance on state exchanges. Regulation authorized tax credits for people buying insurance on state or federal exchanges. Regulation must be consistent with authorizing statute: Political accountability
King v. Burwell, 4thCir., No. 14-1158, July 22, 2014 Same issue, opposite result Language of the law is ambiguous and subject and multiple interpretations and We uphold the rule as a permissible exercise of the agency s discretion.
