Part II: The Law is Complicated, Medicare is Complicated: Navigating Legal Battles and Uncertainty in Medicare Advantage

If you are following along with my self-guided learnings through law and the complexities of the American legal system and how it applies to health care, previously, I posted part one of a review of the various legal battles Centers for Medicare & Medicaid Services is up against.

As a reminder and disclaimer, I’m not a lawyer, and I am equipped with the power of the internet and two semesters in undergrad taking constitutional law.?

One important topic I didn’t cover in part one post The Chevron Doctrine. The Chevron Doctrine is a legal principle established by the Supreme Court in 1984 in the case Chevron U.S.A., Inc. v. Natural Resources Defense Council, Inc. It provides a framework for courts to review an agency's interpretation of a statute it administers. If you are wondering like I was when researching this at 5:00 AM this morning the answer is, “YES” CMS is, in fact, an agency (Don’t go down the rabbit hole as I did, it’s on the about us section of their website) anyways… The doctrine has two steps:

1. If the law is straightforward and clear, the court has to follow the exact wording of the law.
2. If the law is unclear or doesn't address the issue, the court should follow the agency's reasonable interpretation of the law.

Implications of Overturning Chevron for CMS Policy

If the Supreme Court overturns or significantly narrows the Chevron Doctrine in the upcoming cases Loper Bright Enterprises v. Raimondo and Relentless, Inc. v. Department of Commerce, it could have significant implications for the Centers for Medicare & Medicaid Services (CMS) and its ability to interpret and implement the Medicare and Medicaid statutes through regulations and guidance.

Without Chevron deference (without Chevron being a thing that is, you know, a thing we defer to for guidance), courts would no longer be required to defer to CMS's reasonable interpretations of ambiguous statutory provisions in the Medicare and Medicaid Acts. This could lead to more judicial scrutiny and less deference to CMS's policy decisions, potentially disrupting the stability and uniformity of these complex healthcare programs that cover over 160 million Americans.

When reading this and putting the various pieces together I started to realize the implications not only for the current lawsuits the Medicare Advantage program is facing but also for the entire healthcare system at large.?

Connection to the Administrative Procedure Act (APA) 1946

In part one I discussed how important the APA of 1946 is. Well who knew that the APA had a legal baby in 1984 called the Chevron Doctrine…

The Chevron Doctrine is rooted in the Administrative Procedure Act (APA) of 1946, which governs the process by which federal agencies develop and issue regulations. As a refresher, the APA requires agencies to follow certain procedures, such as providing notice and an opportunity for public comment, when promulgating regulations.

The Chevron Doctrine recognizes that when Congress delegates rulemaking authority to an agency and the agency follows the APA's procedures, courts should defer to the agency's reasonable interpretations of ambiguous statutory provisions.

Azar v. Allina Health Services (2019)

The Supreme Court's 2019 decision in Azar v. Allina Health Services illustrates the potential impact of overturning Chevron on CMS policy.? In that case, the Court rejected CMS's interpretation of the Medicare statute regarding reimbursement rates for certain hospitals, finding that CMS had failed to follow the APA's notice-and-comment requirements.

Without Chevron deference, the Court scrutinized CMS's interpretation more closely and held that the agency's failure to follow the APA's procedures meant its interpretation was not entitled to deference. This decision highlights how overturning Chevron could lead to more judicial scrutiny of CMS's interpretations, even when the agency follows proper procedures.

In summary, overturning or narrowing the Chevron Doctrine could significantly impact CMS's ability to interpret and implement the Medicare and Medicaid statutes through regulations and guidance, potentially disrupting the stability and uniformity of these critical healthcare programs.

I got a nerdy laugh when thinking about the AmeriLife lawsuit because it calls into question the Chevron Doctrine and the authority it provides CMS and also simultaneously states that CMS didn’t follow proper procedure and that it violates the APA… So the baby is bad and has to go but the parent should keep on…parenting??

Granted in my limited research I didn’t find a challenge to Chevron in the Amerilife lawsuit but I think it’s all connected…

Will the real Mother please stand up?

(to the tune of The Real Slim Shady)

When I was a kid I remember being taken to church, I vividly remember sitting in the pews starring off looking at the hole in my right sleeve, I wasn't paying attention until the preacher began to tell a story about a King contemplating cutting a baby in half (ok, I was 9 don't judge, it would have gotten any kids attention). Anyway, The Judgment of Solomon, a biblical narrative, offers a poignant parallel to the potential implications of overturning the Chevron Doctrine. In the story, two women claim to be the same child's mother, and King Solomon proposes cutting the baby in half to resolve the dispute. The true mother, driven by her love and concern for the child's well-being, relinquishes her claim to save the baby's life.

Similarly, the Chevron Doctrine has served as a guiding principle, allowing CMS to make decisions in the best interest of Medicare and Medicaid beneficiaries, often the most vulnerable members of society.

Undoing the Chevron Doctrine could significantly undermine CMS's ability to act swiftly and decisively in interpreting and implementing policies that prioritize the well-being of beneficiaries. Without the deference afforded by Chevron, CMS's decisions could be subject to increased judicial scrutiny and potential challenges from corporate and political interests that may prioritize financial considerations over the needs of beneficiaries.

Ultimately, the undoing of the Chevron Doctrine could shift the fate of these vital healthcare programs away from the agency's expertise and commitment to serving the most vulnerable populations. Instead, the advocacy and safety of beneficiaries could become entangled in legal battles and political agendas, potentially compromising the timely delivery of essential healthcare services and jeopardizing the well-being of those who rely on these programs the most. Without this Doctrine, the sweeping decisions made during the COVID-19 Pandemic might not have been as quickly implemented.

Tomorrow I will close out this series with my final thoughts and takeaways so stay tuned!