by Lyle Denniston
With lower federal courts starting to sort out whether President Obama's health-care overhaul violates the Constitution, and with federal agencies starting to write rules to carry out the changes, the U.S. Supreme Court goes back to work after a summer recess facing a series of major legal controversies directly affecting hospitals and other care providers, health insurers, and drug manufacturers.
It will be a new high court, in a sense, taking on those and other issues. Justice Elena Kagan joined the court in August, bringing a younger voice and the third woman to the nine-judge bench. With no prior experience as a judge, and little as a courtroom lawyer, the former Harvard Law School dean and White House legal adviser is expected to bring a more pragmatic view to the court's work.
The coming term of the court probably will not put before the justices the string of cases in which states and others are challenging the constitutionality of the new Patient Protection and Affordable Care Act – the president's signature domestic policy program. The law, 2,500 pages long, will require major changes in nearly every aspect of health care, from insurance to delivery of care. Most of the constitutional challenges so far are aimed at provisions that would, for the first time, mean universal access to insured health care. The cases challenging the law are in preliminary stages in lower federal courts in Florida, Michigan and Virginia, and may not be ready for the Supreme Court until a year from now, at the earliest.
Hospitals as Employers.
Early in the term, though, the court will start examining significant health-law issues, as it turns to the half-dozen cases already accepted for decision. At the top of the agenda is a hotly contested dispute between teaching hospitals and the U.S. Treasury over
payroll taxes for medical residents – a case with a $700 million annual price tag. The specific legal issue is whether residents are students or full-time employees. If they are classified as students, the tax does not apply to them; the IRS regards them as full-time employees. The issue arises in the case of Mayo Foundation for Medical Education v. United States.
A case involving a Peoria, Ill., hospital tests just who in the hospital management or staff can be held legally to blame for discrimination. Hospitals and other care providers, like all employers except those with only a few employees, are required by federal law to follow workplace policies that do not discriminate on the basis of some personal characteristic or situation. At issue in the case of Staub v. Proctor Hospital is whether the hospital can be required to pay damages when a supervisor does not personally engage in discrimination against a worker but causes someone else on the staff to do so – in other words, dupes someone into a biased action. In this case, the bias was allegedly based on hostility to a staff member's military service duties, but the legal principle at issue would apply under any federal law that forbids discrimination – such as race, sex or religious bias – in the workplace.
Quality of Care.
Two other cases in which decisions are assured involve enforcement of two federal laws against state officials responsible for medical care. All 50 states are involved in one of the programs at issue, using federal funds to create state-level organizations to monitor the quality of care for the mentally ill and protect them from abuse and neglect in care facilities. The specific issue in the case of Virginia Office for Protection and Advocacy v. Reinhard is whether a state agency may be sued by one of these organizations for failures in its treatment of the mentally ill.
The second case arises out of a long-running court battle in California over the adequacy of medical and mental health care in the 33 adult state prisons. Finding that overcrowding is the primary cause of the lapses in health care for inmates, a federal court has ordered the state to release more than 40,000 of the prisoners. In the case of Schwarzenegger v. Plata, the court will clarify when a federal court may use that ultimate remedy to cure a constitutional violation in prison health care. The Constitution requires government-run providers to provide a minimum standard of care.
Among cases that have been filed at the Supreme Court but not yet scheduled for decision are three in which the court is awaiting advice from the federal government. One is a very high-stakes appeal by California state officials, asking the court to bar health-care providers or patients from suing a state to stop it from cutting Medicaid payments as it deals with a budget crisis of the kind nearly all states are experiencing. The officials argue in the case of Maxwell-Jolly v. Independent Living Center that only the federal government can enforce a state's duties to provide care under the Medicaid program for the needy, elderly or disabled.
The Supreme Court's new term starts on Oct. 4 and runs until late June.
Veteran legal reporter Lyle Denniston has been covering the U.S. Supreme Court for more than 50 years.
