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SCOTUS For The Average Joe

Average Joe SCOTUS: American Hospital Association v. Becerra

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In another health care snooze fest, SCOTUS is looking at HHS and their shenanigans regarding how they reimburse certain hospitals for drugs through the Medicare Part B program.

The situation is this. You all know hospitals have to give some patients drugs, right? Well, some hospitals, known as 340B hospitals, apparently get their drugs at ultra-low prices. As a result, HHS was like, “Why the fuck are we paying you full price for drugs that you’re buying on the cheap? This is bullshit. We ain’t doin’ this no more.”

HHS also tried to say, “These are our rules to enforce, so this shit isn’t even up for judicial review.” They cited a previous precedent, used often in judicial review, from Chevron U.S.A. v. Natural Res. Def. Council. This precedent basically said that courts can’t just make up their own rules on how a regulation should work. If the regulating body (HHS in this case) has a “reasonable” interpretation of the regulation, and congress specifically didn’t say they should do something different, it’s their regulation to interpret it, and the courts should stay the fuck out of it. This is partly why they think it’s not up for judicial review.

But the 340Bs were like, “Fuck you, we use that money to help people, we’re not getting rich over here. Plus, you can’t just change the rules willy-nilly however the fuck you want. You’ve at least got to do some research first, and set your reimbursement to a number that shows you know what the fuck this shit actually costs.”

Counsel for HHS was like, “Hey, these cost surveys are a lot of work, and the government accounting office so much as told us not to do so many surveys. So we’re just doing what congress told us. Not to mention, many of these hospitals accepted the rate we gave them as perfectly fucking fine. So I don’t see the problem here, buddy.”

After deliberation, SCOTUS was like, let’s address the idea that this shit isn’t up for judicial review. We’re the Supreme Fucking Court. We’re like a regular court, but with sour cream added. We will decide what we can review, thanks. Chevron is a precedent we set. So we could fuck Chevron right in the ass, just like we did with Roe v. Wade if we want, you randy punks. But even if we leave Chevron alone, someone still has to rule on “reasonable interpretation” of the statute. Who do you think that is? That’s right. It’s us, mother fucker. So sit the fuck down with this, “Not open for judicial review” shit.

After that, they had to decide if the rule was reasonable, to which all nine justices were like, “HHS, are you fuckwads on crack? You couldn’t even be bothered to put together an Excel spreadsheet with pricing info and shit? You just cut the price by throwing darts at a dartboard? You know that’s fucking stupid, right? You give us no choice but to side with the AMA you dumb fucks.”

And with that, the HHS were told to go back to the drawing board, and if they want to cut pricing, put together a fucking pricing survey to back up their reasoning for the prices they put forward.

Hear oral arguments and read about the case at the links below.

https://www.oyez.org/cases/2021/20-1114

Justices mull Chevron and voice skepticism of Medicare’s rate cut for hospital drugs
SCOTUS For The Average Joe

Average Joe SCOTUS: Becerra v. Empire Health Foundation

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With this case, its level of complication is only surpassed by it’s level of boringness. I’ve read it multiple times, and have basically determined that it’s just a prime example of how when government writes a law, they only make things overcomplicated and inefficient.

Basically, the gyst is this. Medicare and Medicaid pay hospitals for treating patients. The amount they pay, is a set amount for a set procedure. So if you have to get your taint amputated because you have ass cancer, they might pay $10,000, no matter where you get that shit done.

That being said, there are hospitals, knows as Disproportionate Share Hospitals (DSH). These hospitals exist to help underprivileged Americans get care they might not otherwise be able to afford to get at other care facilities. As such, these hospitals are broke AF, and need money to help cover these extra expenses. DSHs get higher payments, since their patients are poor, and often in worse health, needing more treatment, as a result of their financial situation.

The Health and Human Services agency, has an algorithm to calculate how much to pay these DSHs., which basically looks at their Social Security Insurance (SSI) benefits, time spent in the hospital, and whether Medicare and/or Medicaid pay for it.

They have two separate algorithms for Medicare and Medicaid, to try to catch everyone using one benefit or the other, but then special rules to make sure if a person uses Medicare and Medicaid, they aren’t counted twice.

This is where it gets laughably complicated. The issue is regarding the phrases “entitled to” and “eligible for.” In the English language, they certainly mean two different things. The first means, it’s yours unless a reason is presented it should not be. The latter means it could be yours, if reasons are presented it should be.

But, HHS, apparently unaware of the English language, treated them as essentially the same. Both phrases represented patients whose bills were paid my either Medicare or Medicaid. But then, an appellate court, looking at the phrase “eligible for” came in and was like, “We don’t give a fuck if Medicare or Medicaid paid their bills, if they’re eligible for either Medicare or Medicaid, then they’re to be counted.” This new definition, broadened the “eligible for” phrase, which now makes the two phrases in question mean something different.

So then, HHS was like, “Well fuck you, appellate court. We think they’re the same. So if you’re going to redefine “eligible for” while just redefine “entitled to” to mean the same thing, using your new and broader definition.

So now, SCOTUS must decide, if HHS overstepped its bounds, broadening these definitions of the statute (as opposed to congress rewriting the law, I’m guessing), which would result in billions more taxpayer dollars finding their way to DHS locations around the country.

In a 5:4 decision authored by Justice Kagan, and joined by Justices Thomas, Breyer, Sotomayor, and Barrett, SCOTUS ruled HHS fucking nailed it. That it doesn’t matter if those agencies paid for the care, if the people were covered by these programs, they count, and HHS is well within their scope of authority to interpret the rule that way. As such, these people can be included in the algorithm, whether Medicare paid for their shit or not.

If I understand this right, and fuck me if I don’t, because this shit is confusing. Since there’s only so much money to be paid out, by expanding the number of people covered in the algorithm, it means the available money is divided up and doled out to more hospitals, thus reducing the amount DSHs will get over regular hospitals.

Justice Kavanaugh wrote the dissent, with Roberts, Alito, and Gorsuch joining him. They looked at the statute itself and felt that if Medicare doesn’t pay for the care they received by statute, the patient and DHS aren’t “entitled to” get Medicare to pay for it by adding them into their algorithm anyway.

Hear oral arguments and read about the case at Oyez here, and SCOTUS Blog here.