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American Medical Association v. Becerra

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Supreme Court of the United States
American Medical Association v. Becerra
Docket number: 20-429
Term: 2021
Court: United States Supreme Court
Important dates
Dismissed: May 17, 2021
Court membership
Chief Justice John G. RobertsClarence ThomasStephen BreyerSamuel AlitoSonia SotomayorElena KaganNeil GorsuchBrett KavanaughAmy Coney Barrett
This article is about the court case previously known as American Medical Association v. Cochran; it became American Medical Association v. Becerra when Xavier Becerra became secretary of the U.S. Department of Health and Human Services.

American Medical Association v. Becerra is a U.S. Supreme Court case involving judicial review of administrative agency action and whether that action failed the arbitrary-or-capricious test derived from the Administrative Procedure Act (APA). The case concerned a 2019 rule made by the U.S. Department of Health and Human Services (HHS) that placed more abortion-related restrictions on healthcare providers receiving federal funds under Title X of the Public Health Service Act. The American Medical Association (AMA), other Title X providers, and several states sued, arguing that HHS violated the APA by issuing the rule.[1]

The U.S. Supreme Court dismissed the case in an order released on May 17, 2021. The order stated that the Joe Biden (D) administration had filed a letter saying that it would enforce the challenged regulations outside the state of Maryland while it worked through the notice and comment rulemaking process to override them.[2]

The case was scheduled for argument before the Supreme Court of the United States during the court's October 2021-2022 term. It was consolidated with Oregon v. Becerra and Becerra v. Mayor and City Council of Baltimore.

HIGHLIGHTS
  • The case: HHS made a rule that placed abortion-related restrictions on healthcare providers who receive federal funds through Title X of the Public Health Service Act. The American Medical Association, other Title X providers, and several states sued, arguing that the HHS rule failed the arbitrary-or-capricious test and that the courts should block it from going into effect. After the cases made their way through the federal court system, the 9th Circuit Court of Appeals upheld the HHS rule and the 4th Circuit Court of Appeals held that the HHS rule was invalid. Parties on both sides of the dispute appealed to the U.S. Supreme Court to resolve the disagreement.
  • The issue: The case concerns the Administrative Procedure Act and whether changes in statutes governing Title X of the Public Health Service Act, such as Obamacare, make the challenged HHS rule invalid.
  • The questions presented:

    "1. Whether the Rule is arbitrary and capricious.

    "2. Whether the Rule violates the Title X appropriations act, which requires that 'all pregnancy counseling' under Title X 'shall be nondirective.'

    "3. Whether the Rule violates Section 1554 of the Affordable Care Act, 42 U.S.C. § 18114, which requires that HHS “shall not promulgate any regulation” that harms patient care in any one of six ways, including by 'interfer[ing] with communications' between a patient and her provider."[3]

  • The outcome: The U.S. Supreme Court dismissed the case on May 17, 2021.

  • Why it matters: These cases were an example of the U.S. Supreme Court considering the arbitrary-or-capricious test under the APA.

    American Medical Association v. Becerra came on a writ of certiorari to the United States Court of Appeals for the 9th Circuit. Click here to review the lower court's opinion.[4]

    Oregon v. Becerra came on a writ of certiorari to the United States Court of Appeals for the 9th Circuit. Click here to review the lower court's opinion.[4]

    Becerra v. Mayor and City Council of Baltimore came on a writ of certiorari to the United States Court of Appeals for the 4th Circuit. Click here to review the lower court's opinion.[5]

    Timeline

    The following timeline details key events in these cases:

    • May 17, 2021: The U.S. Supreme Court dismissed the case.[2]
    • March 18, 2021: American Medical Association v. Cochran became American Medical Association v. Becerra when Xavier Becerra became secretary of the U.S. Department of Health and Human Services.[6]
    • February 22, 2021: The U.S. Supreme Court agreed to hear the case.
    • October 1, 2020: The American Medical Association appealed to the U.S. Supreme Court.
    • September 3, 2020: The United States Court of Appeals for the 4th Circuit ruled that the Title X rule failed the arbitrary-or-capricious test.
    • February 24, 2020: The United States Court of Appeals for the 9th Circuit upheld the challenged Title X rule.

    Background

    1991: U.S. Supreme Court upholds HHS anti-abortion regulations related to the federal family planning program under Title X

    In 1988, the U.S. Department of Health and Human Services (HHS) made a rule that blocked healthcare providers receiving federal funds through Title X of the Public Health Service Act from discussing abortion with their patients.[1] The rule also required Title X providers to physically separate their services receiving federal funding from any abortion-related services.[1]

    In Rust v. Sullivan (1991), the U.S. Supreme Court upheld the HHS rule, but President George H.W. Bush (R) directed HHS to revise the rule and then President Bill Clinton (D) directed the agency to repeal the rule in 1993.[1]

    2000: HHS issues rule requiring nondirective counseling on all pregnancy options, including abortion

    HHS made a rule in 2000 that required Title X providers to provide nondirective pregnancy counseling including information about abortion if patients requested such information.[1] The agency held that the 1988 rule "endangered women's lives and health by preventing them from receiving complete and accurate medical information."[1]

    While the 2000 rule required Title X providers to make sure federal funds were not used for abortion activities, it did not require providers to have separate staff and facilities if they also provided abortion services.[1]

    2010: Obamacare includes restrictions on HHS rulemaking authority

    Congress included provisions in Obamacare that prohibited HHS from making any regulation that does the following:[1]

    • Creates any unreasonable barriers to the ability of individuals to obtain appropriate medical care
    • Impedes timely access to health care services
    • Interferes with communications regarding a full range of treatment options between the patient and the provider
    • Restricts the ability of health care providers to provide full disclosure of all relevant information to patients making health care decisions
    • Violates the principles of informed consent and the ethical standards of health care professionals
    • Limits the availability of health care treatment for the full duration of a patient’s medical needs

    2019: HHS issues new anti-abortion regulations under Title X

    The following cases started with a 2019 final rule issued by HHS that changed regulations governing .[7] According to HHS, the rule aimed to "ensure compliance with, and enhance implementation of, the statutory requirement that none of the funds appropriated for Title X may be used in programs where abortion is a method of family planning."[7] To that end, the rule revised earlier regulations from 2000 and made the following changes that are relevant to these cases:[7]

    • Clear financial and physical separation: The rule requires Title X family planning providers to have clear physical and financial separation from locations that provide abortion as a method of family planning.[7]
    • Nondirective pregnancy counseling permitted, not required: The rule eliminates requirements that Title X providers offer pregnancy and abortion counseling. The rule allows Title X funds to go to organizations that provide nondirective counseling, which presents pregnant patients with options while the provider does not suggest or advise one option over another.[7]
    • Referral for abortion as a method of family planning prohibited: The rule prohibits Title X recipients from referring patients for abortion services and blocks Title X funds from going toward performing, promoting, or supporting abortion as a method of family planning.[7]

    American Medical Association v. Becerra and Oregon v. Becerra

    As soon as HHS published the new Title X rule in 2019, the American Medical Association (AMA) and other organizations filed lawsuits in Oregon, Washington, and California, arguing that the rule failed the arbitrary-or-capricious test derived from the Administrative Procedure Act (APA).[1] That test instructs courts reviewing agency actions to invalidate any that they find to be "arbitrary, capricious, an abuse of discretion, or otherwise not in accordance with law."[1] Each of the three district courts that considered the lawsuits ruled against the HHS rule and granted preliminary injunctions, which blocked the rule from going into effect.[1]

    9th Circuit rules in favor of the HHS Title X rule

    HHS appealed the rulings of the district courts and the 9th Circuit agreed to stay the preliminary injunctions, which allowed the HHS rule to go into effect while the lawsuits worked their way through the court system.[1]

    Next, the 9th Circuit upheld the validity of the HHS rule in a 7-4 en banc decision citing the U.S. Supreme Court's decision in Rust v. Sullivan.[1] The court also held that the rule passed the arbitrary-or-capricious test because the agency "properly examined the relevant considerations and gave reasonable explanations" for its decisions."[1]

    Appeal to the U.S. Supreme Court

    The AMA, other organizations, 21 states led by Oregon, and Washington, D.C., all appealed the 9th Circuit's ruling to the U.S. Supreme Court in early October 2020, following a September 2020 decision from the 4th Circuit that upheld injunctions against the HHS rule and held that it violated federal law.[1]

    Becerra v. Mayor and City Council of Baltimore

    The mayor and the city council of Baltimore, Md. filed a lawsuit challenging the HHS Title X rule arguing that because the rule was unlawful it failed the APA's arbitrary-or-capricious test.[8] The district court issued a preliminary injunction, which blocked the rule from going into effect in Maryland.[8] The court held that the rule violated a law that said Title X pregnancy counseling should be nondirective and a provision of Obamacare that prohibits rules that restrict "full disclosure of all relevant information to patients making health care decisions."[8]

    4th Circuit rules against the HHS Title X rule

    After HHS appealed the district court's rulings, the 4th Circuit, sitting en banc, upheld a permanent injunction against the HHS rule and ruled 9-6 that it failed the arbitrary-or-capricious test.[8] The court's decision, issued on September 3, 2020, held that HHS had not offered a satisfactory reason for disagreeing with major medical organizations about whether the rule violated medical ethics and that HHS did not respond adequately to claims that the costs of physical separation between abortion and non-abortion facilities would be higher than estimated.[8]

    Appeal to the U.S. Supreme Court

    HHS appealed to the U.S. Supreme Court, arguing that the court should resolve the disagreement between the rulings of the 4th and 9th Circuits regarding the validity of the 2019 Title X rule.[8]

    Questions presented

    The U.S. Supreme Court agreed to consider the following questions:

    Questions presented:
    1. Whether the Rule is arbitrary and capricious.


    2. Whether the Rule violates the Title X appropriations act, which requires that 'all pregnancy counseling' under Title X 'shall be nondirective.'

    3. Whether the Rule violates Section 1554 of the Affordable Care Act, 42 U.S.C. § 18114, which requires that HHS “shall not promulgate any regulation” that harms patient care in any one of six ways, including by 'interfer[ing] with communications' between a patient and her provider.[3][9]

    Oral argument

    The U.S. Supreme Court dismissed the case before oral argument.[2]

    Outcome

    The U.S. Supreme Court dismissed the case in an order released on May 17, 2021. The order stated that the Joe Biden (D) administration had filed a letter saying that it would enforce the challenged regulations outside the state of Maryland while it worked through the notice and comment rulemaking process to override them.[2][10]

    In dismissing the case, the court also rejected requests from 19 states and the American Association of Pro-Life Obstetricians & Gynecologists to intervene to defend the rule. The order stated that Justices Clarence Thomas, Samuel Alito, and Neil Gorsuch would have allowed the groups to intervene and would have denied the request to dismiss the case.[2][11]

    Commentary about the case

    • Case could become moot before oral argument: Adam Liptak, writing for The New York Times, said that the case could become moot before the U.S. Supreme Court hears oral arguments in the fall because "President Biden has signaled that his administration is reconsidering" the HHS Title X rule.[12] If Biden has HHS reverse the challenged rule, there may no longer be a live case for the court to resolve.

    October term 2021-2022

    See also: Supreme Court cases, October term 2021-2022

    The Supreme Court began hearing cases for the term on October 4, 2021. The court's yearly term begins on the first Monday in October and lasts until the first Monday in October the following year. The court generally releases the majority of its decisions in mid-June.[13]

    The court agreed to hear 68 cases during its 2021-2022 term.[14] Four cases were dismissed and one case was removed from the argument calendar.[15]

    The court issued decisions in 66 cases during its 2021-2022 term. Three cases were decided without argument. Between 2007 and 2021, SCOTUS released opinions in 1,128 cases, averaging 75 cases per year.


    See also

    External links

    Footnotes

    1. 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 U.S. Supreme Court, "American Medical Association v. Cochran, Petition for a Writ of Certiorari," October 1, 2020
    2. 2.0 2.1 2.2 2.3 2.4 U.S. Supreme Court, "Order List: 593 U.S.," May 17, 2021
    3. 3.0 3.1 U.S. Supreme Court, "American Medical Association v. Cochran, Question presented," February 22, 2021
    4. 4.0 4.1 United States Court of Appeals for the 9th Circuit, "California v. Azar," February 24, 2020
    5. United States Court of Appeals for the 4th Circuit, "Mayor v. Azar," September 3, 2020
    6. The Washington Post, "Becerra squeaks through confirmation vote to become HHS secretary," March 18, 2021
    7. 7.0 7.1 7.2 7.3 7.4 7.5 Federal Register, "Department of Health and Human Services, Final Rule: Compliance with Statutory Program Integrity Requirements," March 4, 2019
    8. 8.0 8.1 8.2 8.3 8.4 8.5 U.S. Supreme Court, "Alex M. Azar II v. Mayor and City Council of Baltimore, Petition for a Writ of Certiorari," October 2020
    9. Note: This text is quoted verbatim from the original source. Any inconsistencies are attributable to the original source.
    10. U.S. Supreme Court, "American Medical Association v. Becerra, Letter from the Office of the Solicitor General," May 3, 2021
    11. U.S. Supreme Court, "American Medical Association v. Becerra, Docket," May 17, 2021
    12. The New York Times, "Supreme Court to Hear Cases on Abortion Referrals and Immigration," February 22, 2021
    13. SupremeCourt.gov, "The Supreme Court at Work: The Term and Caseload," accessed February 4, 2021
    14. Consolidated cases are counted as one case for purposes of this number.
    15. U.S. Supreme Court, "Order List: 593 U.S.," May 17, 2021