Similarly, simplistic proposals to require "site neutrality" in payments must be countered with well-stated, fact-based opposition as to why they will, among other things, harm hospitals’ ability to provide 24/7 care or serve as a safety net for vulnerable populations.
For insurers accountable for care delays or burdensome prior authorization tactics, especially Medicare Advantage plans, lawmakers must use precise language to ensure timely and fair patient care.
Under Chevron, the Supreme Court articulated a two-step test to determine whether a federal agency’s interpretation of a statute should be controlling on the law’s meaning. Step one is determining whether the statutory language is clear. If it is, then that is the end of the inquiry, and a court should not accept a contrary agency interpretation. If the statute is silent or ambiguous on a legal issue, then step two requires the court to defer to the agency interpretation if it offers a "permissible construction of the statute.”
Chief Justice John Roberts, joined by a majority of his colleagues, rejected the Chevron test, arguing that it violates fundamental constitutional principles established in early landmark cases like Marbury v. Madison. In the 1803 ruling, then-Chief Justice John Marshall famously declared, “It is emphatically the province and duty of the judicial department to say what the law is.”
In the June decision, the majority opinion emphasized that it is the judicial branch’s duty to interpret the law, not the executive agencies. While courts can seek guidance from agencies, mandatory deference on legal questions is inconsistent with the constitutional separation of powers, the justices said.
The dissenting justices, however, maintained that for decades, the Chevron deference allowed courts to rely on agencies' expertise in complex policy areas. Thousands of cases have been decided using this principle, highlighting its long-standing influence on the legal landscape.
The recent decision has sparked intense debate among legal analysts. Supporters argue that the Chevron deference was controversial from the beginning and gave too much undelegated power to agency personnel. Detractors, on the other hand, criticize the reversal of a decades-old precedent, arguing that society benefits when agencies resolve ambiguities rather than courts. They also fear that the decision will spawn significant litigation to define the appropriate level of “guidance” courts should take from agencies.
Both sides may be overstating the ultimate impact. Roberts acknowledged that, in appropriate circumstances, courts should give serious consideration to a regulatory agency’s guidance. This suggests the decision's effects might be more moderate than anticipated. One potential outcome is that agencies may adopt more limited, consistent positions on statutes, regardless of changes in administration, promoting stability and expertise in agency decision-making.
Following Loper Bright, look for judges to more actively disregard executive agency interpretations, reinforcing their role in interpreting the law. This underscores the need for the healthcare community to offer clear and direct guidance to lawmakers on our most critical priorities. As healthcare leaders, we have a chance to engage with lawmakers and deepen their understanding of our industry's opportunities and challenges. This is our moment to increase our influence on policymaking, driving meaningful change beyond the standard rule-making process.
Joseph Impicciche is CEO of St. Louis-based Ascension, which operates 140 hospitals in 18 states.