Major changes to Medicare payments, the Affordable Care Act and labor issues could be on the horizon depending on the Trump administration's next moves in court.
The administration must decide whether to defend the federal government's position in a series of key healthcare cases that could reshape coverage requirements under the ACA, influence billions of dollars in hospital payments and restructure fundamental workforce policies.
Here are some cases to watch.
Emergency medical law
The Supreme Court in June sent a key abortion-emergency medicine case, Moyle v. United States, back to the 9th U.S. Circuit Court of Appeals.
The case focuses on whether an Idaho state law banning abortion except to prevent a patient's death was a violation of the federal Emergency Medical Treatment and Active Labor Act of 1986.
Following the 2022 overturn of Roe v. Wade, the Health and Human Services Department conditioned federal funding for hospitals by requiring them to offer patient-stabilizing emergency treatment including miscarriage management if a physician deems it necessary. Hospitals in Idaho and states with similarly strict abortion laws have been caught between complying with federal statute and state law while litigation is ongoing.
President Donald Trump has said he believes in limited exceptions to protect the life of the mother but noted in an April Truth Social post that abortion policies should be left to the states.
The conservative playbook Project 2025 calls for HHS to rescind the Biden administration’s EMTALA guidance and withdraw from the Moyle case.
340B challenges
There are four active cases that could change how pharmaceutical companies give drug discounts to providers that care for large numbers of low-income people.
Sanofi, Lilly, Johnson & Johnson and Bristol Myers Squibb each filed lawsuits in quick succession last year arguing the Health Resources and Services Administration does not have the authority to restrict how manufacturers manage their drug discounts. Each company sought to implement a new rebate model that would charge 340B-enrolled disproportionate share hospitals full price for medications up front and administer discounts later.
The lobbying group 340B Health and two safety-net hospitals, Worcester, Massachusetts-based UMass Memorial Medical Center and Zanesville, Ohio-based Genesis Healthcare System, recently asked the court to join as co-defendants with HHS in each case. All four cases were filed in the U.S. District Court for the District of Columbia.
The massive 340B program, which allows hospitals to buy outpatient drugs at a discount for uninsured and low-income patients, could become a target of conservative spending cuts. Hospitals and other 340B entities purchased more than $66 billion in covered outpatient drugs under the program in 2023, according to HRSA. Critics of the program have said it is rife with wasteful federal spending on duplicate discounts and discounts for ineligible providers.
Noncompete rules
Under the Biden administration, the Federal Trade Commission in October appealed a ruling that blocked its controversial 2024 rule banning the use of non-compete clauses in many employment contracts.
Trump’s new FTC Chair, Andrew Ferguson, has signaled that the commission under his tenure would fight impediments to competition.
"I think one of the most important things that the FTC will do under my watch is focusing very intently on attacking anti-competitive conduct that hurts America's workers," Ferguson told Fox News Thursday. "I think that is part and parcel of what President Trump was elected to do.”
Safety-net payments
A handful of ongoing cases in lower courts, plus a case at the Supreme Court, could change how the Centers for Medicare and Medicaid Services calculates Medicare and Medicaid disproportionate share hospital payments, which are meant to support providers that treat large numbers of low-income patients.
Under law, CMS calculates DSH payments based on factors such as a hospital's location, its bed count and the number of low-income patients it serves. CMS distributed $16 billion in Medicaid DSH payments and $10.1 billion in Medicare DSH payments between October 2022 and October 2023, according to federal data.
Hospitals have criticized the formula, arguing they miss out on billions of dollars in critical payments.
The Cato Institute, a conservative think tank, wrote in a 2023 brief that the current methodology is “outdated and leaves ample room for fraud,” meaning the program could pique the fraud-focused Department of Government Efficiency team's interest.
Preventive care
The Trump administration said last week it would continue to defend the federal government in a suit before the Supreme Court that could affect preventive care coverage requirements under the Affordable Care Act.
The case, Braidwood v. Becerra, seeks to determine the legality of whether the health law can require insurers to cover interventions recommended by the U.S. Preventive Services Task Force without out-of-pocket costs. That includes an array of care options such as cancer screenings and medications to prevent HIV.
The task force is an independent panel within HHS, and the Agency for Healthcare Research and Quality appoints its members. The panel exercises enough decision-making power that panel members should be subject to Senate confirmation, the suit alleges.
A decision in the case is expected in June.
Nursing home staffing
A nursing home staffing rule finalized by the Biden administration is under heavy fire from all three branches of the federal government.
Nursing home trade groups the American Health Care Association, LeadingAge, the Texas Health Care Association and other organizations filed a lawsuit last spring against HHS over the staffing rule that would require facilities to have a registered nurse on-site 24 hours per day, 7 per days a week, and would require them to meet a minimum level of clinician care per resident per day.
Lawmakers have made efforts to block the rule, and CMS could choose to issue a regulation blocking it, which would make the case moot.
