Health Care Supreme Court Cases

Early in the 21st century, health care has taken center stage for many Americans. The Affordable Care Act, popularly known as Obamacare, transformed the market for individual health insurance in an effort to expand access. The Supreme Court has heard several complex cases involving this law, which has weathered challenges so far. Meanwhile, the COVID-19 pandemic has fueled controversy over vaccination mandates. A pair of older Supreme Court cases illuminate that topic.

End-of-life decisions may raise difficult legal questions. Although a patient generally has a right to refuse medical treatment, the Supreme Court has allowed states to limit this right when the patient cannot clearly express their wishes. Moreover, a ban on assisted suicide may be compatible with the Constitution. A state that permits assisted suicide, on the other hand, may be entitled to be free from federal interference.

The Supreme Court also has addressed health care issues in areas as diverse as antitrust laws, drug safety, and religious freedom. Some health care cases implicate the doctrine of preemption, which provides that federal laws supersede conflicting state laws. For example, the Employee Retirement Income Security Act of 1974 (ERISA) generally preempts state laws related to employer-sponsored health plans.

Below is a selection of Supreme Court cases involving health care, arranged from newest to oldest.

Little Sisters of the Poor Saints Peter and Paul Home v. Pennsylvania (2020)

The Department of Health and Human Services may promulgate exemptions to the ACA to allow for-profit organizations to exempt themselves from the contraceptive coverage requirement on religious or moral grounds.

King v. Burwell (2015)

Congress intended the tax credits authorized under the ACA to be available through both state and federal exchanges.

North Carolina State Board of Dental Examiners v. FTC (2015)

State-action antitrust immunity does not apply to a state board that places restraints on a medical occupation when a majority of its decision-makers, elected by others in the occupation, are active market participants in the occupation, and the state does not actively supervise the board, nor has the board acted pursuant to a clearly articulated and affirmatively expressed state policy.

Burwell v. Hobby Lobby Stores, Inc. (2014)

The Religious Freedom Restoration Act (RFRA) permits a closely held for-profit corporation to deny its employees the health coverage of contraceptives to which the employees are otherwise entitled by the ACA, based on the religious objections of the corporation’s owners.

Mutual Pharmaceutical Co. v. Bartlett (2013)

Design defect claims based on generic drugs are preempted by federal law.

FTC v. Actavis, Inc. (2013)

Reverse payment settlement agreements in the pharmaceutical industry are not per se illegal but should be analyzed according to the rule of reason.

National Federation of Independent Business v. Sebelius (2012)

The individual health insurance mandate under the Affordable Care Act was a permissible use of Congress’ taxing power, but the way in which the ACA conditioned all Medicaid funding on states’ compliance with a significant expansion was not a valid use of Congress’ spending power.

PLIVA, Inc. v. Mensing (2011)

Failure-to-warn claims based on generic drugs are preempted by the FDA’s interpretation of federal drug regulations.

Wyeth v. Levine (2009)

State tort law claims, such as failure-to-warn claims, are not preempted by the FDCA with regard to prescription drugs, but they are an additional level of safeguards for consumers that complements the goals of the FDA.

Riegel v. Medtronic, Inc. (2008)

The Medical Device Amendments to the Food, Drug, and Cosmetic Act preempt state common-law claims challenging the safety or effectiveness of medical devices marketed in a form that received pre-market approval from the FDA.

Gonzales v. Oregon (2006)

Even if a drug falls within the Controlled Substances Act, a doctor can prescribe it for a patient if it is allowed in the context of assisted suicide for terminally ill individuals under state law.

Gonzales v. Raich (2005)

State laws permitting the medical use of marijuana do not prevent Congress from prohibiting its use for any purpose in those states under the Commerce Clause.

Aetna Health Inc. v. Davila (2004)

ERISA prevents individuals from suing HMOs in state court for pure eligibility decisions.

Rush Prudential HMO, Inc. v. Moran (2002)

HMOs may be insurers and thus subject to state regulation of insurers. State laws directed toward the insurance industry are saved from preemption under ERISA’s saving clause.

Pegram v. Herdrich (2000)

Mixed treatment and coverage eligibility determinations made by health maintenance organizations (HMOs) through physicians are not fiduciary acts subject to ERISA liability.

Washington v. Glucksberg (1997)

A state law banning physician-assisted suicide does not violate the Due Process Clause.

Vacco v. Quill (1997)

A state does not violate the Equal Protection Clause by banning assisted suicide while permitting patients to refuse medical treatment.

Inter-Modal Rail Employees Ass’n v. Atchison, Topeka & Santa Fe Railway Co. (1997)

The power to amend or abolish a welfare benefit plan does not include the power to discriminate against the plan’s participants and beneficiaries for the purpose of interfering with their attainment of rights under the plan.

New York State Conference of Blue Cross & Blue Shield Plans v. Travelers Ins. Co. (1995)

A law operating as an indirect source of merely economic influence on administrative decisions should not suffice to trigger ERISA preemption.

FMC Corp. v. Holliday (1990)

ERISA’s deemer clause demonstrates Congress’ clear intent to exclude from the reach of the saving clause self-funded ERISA plans by relieving them from state laws purporting to regulate insurance. State laws directed toward such plans are preempted because they relate to an employee benefit plan but are not saved because they do not regulate insurance.

Cruzan v. Director, Missouri Dep’t of Health (1990)

A state may require clear and convincing evidence of an incompetent individual’s desire to withdraw life-sustaining treatment before the family may terminate life support for that individual.

Employment Division v. Smith (1990)

A law prohibiting certain drug use is constitutional under the Free Exercise Clause if it is facially neutral and generally applied.

Firestone Tire & Rubber Co. v. Bruch (1989)

For disclosure purposes, a “participant” in an ERISA plan means an employee in currently covered employment (or reasonably expected to be in currently covered employment), or a former employee who has a reasonable expectation of returning to covered employment or who has a colorable claim to vested benefits. To establish that they may become eligible for benefits, a claimant must have a colorable claim that they will prevail in a suit for benefits, or that eligibility requirements will be fulfilled in the future.

Fort Halifax Packing Co., Inc. v. Coyne (1987)

To be preempted by ERISA, a state statute must have some connection with or reference to a plan.

Pilot Life Ins. Co. v. Dedeaux (1987)

ERISA preempts state common law tort and contract actions asserting improper processing of a claim for benefits under an insured employee benefit plan.

Arizona v. Maricopa County Medical Society (1982)

Maximum fee agreements between medical societies and member doctors are per se illegal as price-fixing agreements under Section 1 of the Sherman Act.

Whalen v. Roe (1977)

Requiring healthcare providers to store the private information of patients who receive prescriptions for drugs that can be illegally abused is permissible, despite the privacy rights of the patients.

Prince v. Massachusetts (1944)

The government may restrict parental authority in the interests of child health and welfare.

Zucht v. King (1922)

City ordinances that require that students be vaccinated to attend school and that vest broad discretion in health authorities to determine when and under which circumstances such a requirement will be enforced do not violate the Fourteenth Amendment.

Jacobson v. Massachusetts (1905)

A state may enact a compulsory vaccination law, since the legislature has the discretion to decide whether vaccination is the best way to prevent smallpox and protect public health. The legislature may exempt children from the law without violating the equal protection rights of adults if the law applies equally among adults.