Oklahoma v. Dept. of Health & Human Servs A case that keeps health policymakers up late at night.
On the surface, it involves a relatively low-key fight against abortion. The Biden administration requires recipients of federal Title X grants — a federal program that pays for family-planning services — to present patients with “unbiased, factual information” about all of their family-planning options, including abortion. This requirement may be complied with by grant recipients Providing patients with a national call-in number which can inform those patients about abortion providers.
Oklahoma has long received Title X grants to fund health programs in the state. After receiving a $4.5 million grant in 2023, however, the state decided it would no longer require patients to provide a call-in number. Accordingly, the administration revoked Oklahoma’s grant.
Now, however, Oklahoma is asking the Supreme Court to allow Title X funds to be received without complying with the call-in number rule. Its case has landed on the court’s shadow docket, a mix of emergency motions and other expedited matters that judges sometimes decide without full briefing or oral arguments.
Oklahoma raises two arguments to justify its preferred outcome, one of which would potentially undermine much of Medicare and Medicaid. In short, states claim that federal agencies may not set rules that states must follow when they accept federal grant money, even if Congress expressly authorizes an agency to do so. Taken seriously, Oklahoma’s proposed limits on the powers of federal agencies would profoundly transform how many of the largest and most productive federal programs are administered.
As the Judiciary noted therein Oklahoma In short, “Medicare’s ‘Conditions of Participation’ for Single Hospitals Spanning about 48 pages in the Code of Federal Regulations.” All of these rules, and countless other federal regulations for Medicare, Medicaid, and other programs, could cease to operate overnight if the justices accepted Oklahoma’s more radical argument. (Oklahoma’s second argument, which claims that the call-in rule Unlike a different federal law, this one is less radical and more rational than the first.)
The battle over whether to provide Title X grant recipients with certain abortion-related information will be familiar to those who closely follow abortion politics. In 1988, the Reagan administration prohibited Title X grant recipients from providing any abortion counseling, and the Supreme Court upheld the Reagan administration’s authority to do so. rust v. Sullivan (1991).
Since then, the policy has been sporadic Varies depending on which party controls the White House. The Reagan-era policy was dropped during the Clinton administration and then revived by the Trump administration in 2019. Biden’s administration changed the policy again during his first year in office.
However, the state of Oklahoma argues that the current administration exceeded its authority when it enacted a rule that is similar to regulations that have been in effect for most of the past few decades.
At huge stake Oklahoma case, briefly explained
The Supreme Court has long held that Congress can place conditions on a federal grant program and states must comply with those conditions if they want to receive the grant. In South Dakota vs. Dole (1987), however, the Court placed some limits on this power to impose conditions on grants, including that these conditions must be unambiguous so that states “may exercise their discretion while being aware of the consequences of their participation.”
the rust According to the federal statute governing Title X that “[n]Funds appropriated under this subchapter shall be used in programs where abortion is a method of family planning.” does not speak Title X programs may refer patients to other medical providers who offer abortions. Thus, the law regarding such referrals is “ambiguous,” and the court concluded that the Reagan administration could resolve this ambiguity by prohibiting abortion-related referrals.
If all this law holds, it will have a strong argument in its pending case before the Oklahoma Supreme Court. doll ruled that the terms of federal grants must be unambiguous and the rust The ruling is unclear on whether Title X patients must be provided with information about abortion. So the naked law does not unambiguously imply to Oklahoma that it will refer Title X patients to a call-in number if they need information about abortion.
But so are Title X statutes There is a provision which states that “grants and contracts made under this subchapter shall be made in accordance with such regulations [Health and Human Services (HHS)] as the Secretary may promulgate,” and that Title X grants are “subject to such conditions as the Secretary may determine to be appropriate that such grants will be effectively used for the purposes for which they were made.”
Thus, the statute unequivocally gives HHS the authority to write mandatory rules. And Oklahoma knew when it received a Title X grant that it was subject to those rules, including the Biden administration’s rules requiring grant recipients to provide patient call-in numbers.
Oklahoma, however, is arguing Congress Cannot delegate such governing powers to federal agencies. If it wants to impose a condition on a federal grant, Congress must write the exact terms of that condition into statute.
The implications of this argument are staggering, given the scads of agency-drafted rules governing federal grant programs. The Medicare rules mentioned in the Justice Department brief cover everything from, for example Hospital license from Complaints filed by patients from Corporate Governance of Hospitals Receiving Medicare Funds. The rules governing Medicaid can be more complicated. They are more vulnerable to a legal challenge under Oklahoma’s legal theory because Medicaid is administered almost entirely by states that receive federal grants.
Oklahoma, in other words, is asking the court to fundamentally change how almost every single aspect of hospital and health care administration and provision in the United States works — and that’s not even accounting for all the federal grant programs that aren’t health care-related. .
It is unfortunate, to say the least, that this issue arises in the context of the abortion controversy. About a year ago, the Supreme Court rejected a similar — and similarly radical — legal theory that would have rendered large swaths of federal Medicaid law virtually unenforceable. The facts of that case, however, involved allegations of elder abuse by a nursing home and not the politically charged issue of abortion.
question in Oklahoma Whether this Court, with its 6-3 Republican supermajority, would show similar wisdom in an abortion-related case is at issue.
If the justices are determined to rule in Oklahoma’s favor, there’s a way to do it without dismantling Medicare and Medicaid.
Oklahoma raised a second legal argument in its lawsuit that would allow it to receive a Title X grant, but would not require the courts to throw much of the U.S. health care system into disarray. The Biden administration’s requirement that Title X providers must provide a call-in number to patients seeking abortion information is arguably at odds with a federal law called the Weldon Amendment.
D Weldon Amendment Title X prohibits funds from being distributed to government agencies that “may discriminate against any institutional or individual health care entity that does not provide, pay for, provide coverage for, or refer abortions.”
Judge who heard three appeals earlier Oklahoma the case The Weldon Amendment is divided on whether it bans the rule from the Biden administration. The two judges concluded, among other things, that providing a patient with a phone number that allows them to learn about abortion is not the same thing as referring a patient for an abortion, and thus Biden’s rule was approved. A judge (who, notably, is a Biden appointee) disagreed.
In any case, Oklahoma’s Weldon Amendment argument gives this Supreme Court a way to rule against the Biden administration’s pro-abortion access policies without doing the violence to Medicare and Medicaid contemplated by Oklahoma’s other argument. If the justices are determined to rule in Oklahoma’s favor, anyone who cares about maintaining a stable health care system in the United States should root for the court to adopt this less radical option.
