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)

Author: Clarence Thomas

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


King v. Burwell (2015)

Author: John Roberts

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


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

Author: Anthony Kennedy

A non-sovereign actor controlled by active market participants enjoys state action antitrust immunity only if the challenged restraint is clearly articulated and affirmatively expressed as state policy, and the policy is actively supervised by the state.


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

Author: Samuel A. Alito, Jr.

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 federal Patient Protection and Affordable Care Act, based on the religious objections of the corporation's owners. More generally, protecting the free exercise rights of closely held corporations protects the religious liberty of the people who own and control them.


Mutual Pharmaceutical Co. v. Bartlett (2013)

Author: Samuel A. Alito, Jr.

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


FTC v. Actavis, Inc. (2013)

Author: Stephen Breyer

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)

Author: John Roberts

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. Also, the Commerce Clause gives Congress the power to regulate commerce but not to compel it.


PLIVA, Inc. v. Mensing (2011)

Author: Clarence Thomas

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


Wyeth v. Levine (2009)

Author: John Paul Stevens

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)

Author: Antonin Scalia

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)

Author: Anthony Kennedy

Chevron deference is not accorded merely because a statute is ambiguous, and an administrative official is involved. A rule must be promulgated pursuant to authority that Congress has delegated to the official. Also, 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)

Author: John Paul Stevens

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)

Author: Clarence Thomas

ERISA prevents individuals from suing HMOs in state court for pure eligibility decisions. Also, if an individual at some point in time could have brought their claim under ERISA Section 502(a)(1)(B), and no other independent legal duty is implicated by a defendant's actions, the individual's cause of action is completely preempted.


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

Author: David Souter

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)

Author: David Souter

Mixed treatment and eligibility decisions by health maintenance organization (HMO) physicians are not fiduciary decisions under ERISA.


Vacco v. Quill (1997)

Author: William Rehnquist

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


Washington v. Glucksberg (1997)

Author: William Rehnquist

A “right” to assistance in committing suicide is not a fundamental liberty interest protected by the Due Process Clause. Thus, a state law banning physician-assisted suicide does not violate due process.


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

Author: Sandra Day O’Connor

The power to amend or abolish an employee 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)

Author: David Souter

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)

Author: Sandra Day O’Connor

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 Dept. of Health (1990)

Author: William Rehnquist

The Constitution does not forbid a state from requiring that evidence of an incompetent person's wishes as to the withdrawal of life-sustaining treatment be proved by clear and convincing evidence.


Employment Division v. Smith (1990)

Author: Antonin Scalia

A law prohibiting certain drug use is constitutional under the Free Exercise Clause if it is facially neutral and generally applied. More generally, the Free Exercise Clause does not relieve an individual of the obligation to comply with a law that incidentally forbids (or requires) the performance of an act that their religious belief requires (or forbids) if the law is not specifically directed to religious practice and is otherwise constitutional as applied to those who engage in the specified act for non-religious reasons.


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

Author: Sandra Day O’Connor

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)

Author: William Brennan

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)

Author: Sandra Day O’Connor

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)

Author: John Paul Stevens

Horizontal agreements to fix maximum prices are on the same legal footing as agreements to fix minimum or uniform prices. More specifically, 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)

Author: John Paul Stevens

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)

Author: Wiley Blount Rutledge

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


Zucht v. King (1922)

Author: Louis Brandeis

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)

Author: John Marshall Harlan

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.