Supreme Court Rulings Deliver Victories and Challenges for Public Health.
Supreme Court Rulings Deliver Victories and Challenges for Public Health
The Supreme Court’s 2024-2025 term concluded with rulings that will have long-term consequences for civil rights, federal authority, gun regulations, the environment, and more. Below, SPH faculty members discuss the implications of several of these cases.
Mahmoud v. Taylor
In Mahmoud v. Taylor, the Court ruled that parents can excuse their children from classes that incorporate LGBTQ+ books in their lessons. This ruling is problematic on multiple fronts, says Kimberly Nelson, associate professor of community health sciences.
“This ruling creates a legal precedent to discriminate against LGBTQ+ content and asserts that LGBTQ+ people are not worthy of recognition in public school curricula,” says Nelson, who studies inequities among marginalized youth. “This precedent lays the groundwork for content portraying other marginalized groups to similarly be targeted. Further, it codifies that it is appropriate and reasonable to discriminate against specific groups.”
The ruling increases parents’ ability to excuse their children not only from lessons that incorporate LGBTQ+ books into their lessons, but also lessons that they believe may include content that is not aligned with their beliefs, which may result in a nonstandardized curriculum for students, Nelson says.
These changes will have a chilling effect on the content public schools approve for their classroom, she adds.
“The administrative burden of knowing which children should be removed from any given lesson and the logistical burden of finding a place where those excused children can go during those lessons is large enough that instead of figuring out systems to overcome those burdens it will be easier for school districts to only approve content that is not considered “controversial.”
All of these impacts are likely to have detrimental effects on the health and wellbeing of LGBTQ+ students, and all students, Nelson says. Substantial research has linked inclusive curricula to decreased bullying, increased acceptance of self and others, and increased student mental wellbeing.
“Ultimately this ruling is going to limit the diversity of content that students are exposed to in public schools and instill the idea that it is ok to discriminate against certain groups,” says Nelson. “These combined effects are likely to be harmful to students across the board, and particularly harmful for students who are members of or have family who are members of the groups that are being discriminated against.”
Hear more from Nelson about the likely consequences of another recent Supreme Court case, in which a 6-3 majority ruled to uphold a Tennessee ban on gender-affirming care for transgender youth.
Bondi v. VanDerStok
In Bondi v. VanDerStok, the Supreme Court upheld 2022 federal regulations on “ghost guns,” ruling that the Gun Control Act of 1968 gave the Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF) the authority to regulate at least some weapons parts kits that can be converted into an operational gun, gun frame, or receiver.
“Prior to the ATF’s application of the Gun Control Act [GCA], these kits were not subject to federal regulations that required, for example, purchaser background checks or the firearm to contain serial numbers,” says Michael Ulrich, associate professor of health law, policy & management. “As a result, they were difficult, if not impossible, to trace and often referred to as ghost guns.”
In a 7-2 majority opinion, Justice Neil Gorsuch focused on Congress’s efforts to define firearms broadly in the GCA to include weapons parts that were designed to replicate a gun. This broader definition was also, in part, intended to minimize criminals’ access to firearms, Ulrich says, with the majority citing the stark rise in ghost guns retrieved from crime scenes—from 1,600 in 2017 to more than 19,000 in 2021.
“The Court’s decision could help to mitigate the increase and negative consequences of ghost guns, with some companies already suffering having to cease production due to lawsuits and regulatory changes,” Ulrich says. “Polymer80 is one such company, and their ‘Buy Build Shoot’ kit was utilized as an example by the Court because a person with no experience was able to build a firearm with it in 21 minutes using common tools and YouTube.”
Yet, the Court refrained from defining what time duration or effort might push a product from being properly categorized as readily convertible, he notes, which raises questions about how far this ruling extends and leaves open the possibility for lawsuits that challenge the ATF’s efforts to regulate products designed to evade the law. The Court has also proven to be inconsistent around the issue of ghost guns—in last year’s Garland v. Cargill ruling, it struck down the ATF’s application of Congress’s machine-gun ban to bump stocks.
“VanDerStok will hopefully deter companies from producing more evasive products that are a threat to the public’s health, but the impact of the decision moving forward is difficult to predict,” Ulrich says. “With the current administration’s deregulatory efforts and the Supreme Court’s inconsistent rulings for ATF regulations, it is unclear how much administrative agencies will be able to continue to address violence and crimes perpetuated by firearms in the future.”
Hear more from Ulrich on the Court’s conflicting perspectives on ghost guns in this opinion piece in The Regulatory Review.
Medina v. Planned Parenthood South Atlantic
In Medina v. Planned Parenthood South Atlantic, the Court ruled that the enforcement of a 1987 provision of Medicaid allowing patients to choose any qualified provider for their care—including Planned Parenthood clinics—is up to Congress not the courts and therefore patients do not have grounds to sue South Carolina state officials under federal law.
Paul Shafer, associate professor of health law, policy & management, worries that more states will likely follow South Carolina’s example in restricting access to Planned Parenthood through Medicaid, substantially reducing access to primary, sexual, and reproductive health care, including non-abortion related services.
“This is a concerning ruling for patients and their freedom to choose their health care providers, representing hypocrisy at its finest,” says Shafer, co-director of the Medicaid Policy Lab at SPH. “Saying that patients cannot use a specific provider because of other types of care that they provide is a slippery slope, curtailing physicians’ rights to provide care deemed safe and appropriate by relevant scientific bodies and medical societies.”
Kennedy v. Braidwood Management, Inc.
In Kennedy v. Braidwood Management, Inc., the Court addressed the question of whether the Secretary of Health & Human Services has the authority to appoint members to the U.S. Preventative Services Task Force (USPSTF) and whether that task force can determine which preventative-care services must be covered by commercial insurance plans under the Affordable Care Act (ACA). The Court’s decision appears to protect this key benefit of the ACA, says Shafer, with a major caveat.
“The ruling affirmed that the Secretary of Health and Human Services has the power to replace USPSTF members—as Robert F. Kennedy, Jr. already has done with a key CDC vaccine advisory panel—or block its recommendations,” says Shafer. “Making what had been evidence-based guidance for primary care more politicized could have dire implications for access to key prevention measures, in particular for sexual and reproductive health.”
The task force was established in 1984 as a scientifically independent, volunteer panel of national experts in disease prevention and evidence-based medicine, with the mission of making evidence-based recommendations about clinical preventive services.
Hear more Shafer about the Braidwood ruling in this article published in The Conversation.
FDA v. Wages and White Lion Investments, L.L.C.
In FDA v. Wages and White Lion Investments, L.LC., the Court unanimously held that the FDA did not act “arbitrarily and capriciously” in denying the applications of Wages and White Lion Investments, L.L.C. (Triton Distribution), manufacturers of flavored nicotine liquids for refillable e-cigarettes, to market their new products.
The decision supports the FDA’s historically cautious handling of e-cigarettes, says Jennifer Ross, associate professor of health law, policy and management. “Vaping devices are a complex and challenging issue because of the potential benefit of a harm-reduction product for adults who smoke cigarettes and have not been able to successfully quit cigarettes using other methods [for whom] completely switching to e-cigarettes could reduce health risks associated with smoking traditional cigarettes. However, the evidence is clear that flavored tobacco products are appealing to youth and may result in initiation and addiction.”
The Court’s decision reaffirmed the FDA’s interpretation of the Tobacco Control Act and the agency’s choice to require more scientific evidence of a product’s public health benefits to be approved. Ross agrees that it is important for research, by industry and non-industry scientists alike, to continue to better understand the role that flavors play in helping adults quit smoking traditional cigarettes.
“Adults like flavors, too, but we do not have evidence that flavored e-cigarettes are better at helping adults completely quit cigarette smoking compared to unflavored e-cigarettes,” she says. “There needs to be more effective messaging about the relative harms of different tobacco/nicotine products so that consumers, both youth and adults, better understand the continuum of harm of tobacco products, as well as understand the harms associated with using multiple tobacco products.”
In the meantime, Ross recommends that policymakers consider a low-nicotine product standard for combustible tobacco products. Alongside smoking cessation programs, making cigarettes and cigars minimally addictive would lead an estimated 13 million adults to quit smoking and have substantial public health benefits in just a year’s time, she says.
On this front, Ross finds Congress’s recent cuts to Medicaid deeply concerning. Medicaid covers many smoking cessation treatments, so the millions of people poised to lose their Medicaid coverage will also lose access to cessation benefits, she says. Even people with private insurance could be affected if the loss of federal funding forces state-run cessation programs to close their doors.
Going forward, Ross is less confident in the FDA’s ability to balance concerns surrounding flavored products, citing what she sees as the federal government’s prioritization of deregulation, disregard for science, and restructuring of the FDA—including the dismissal of experts from the Center for Tobacco Products.
Diamond Alternative Energy LLC v. EPA
In Diamond Alternative Energy LLC v. EPA, the Court ruled that fuel producers have legal standing to challenge the 2022 EPA waiver approving California regulations requiring automakers to manufacture more electric vehicles (EVs) and fewer gas-powered vehicles. In a majority opinion authored by Justice Brett Kavanaugh, the court reasoned that invalidating the waiver could restore fuel sales and thus redress the monetary injuries fuel producers experienced as a result of the regulations.
This waiver was one tool of many to improve air quality and without it, California loses a tool to reduce these outcomes, says Jonathan Buonocore, assistant professor of environmental health.
“Air pollution from traffic leads to premature death, hospitalization from respiratory and cardiovascular disease, asthma, neurodegenerative diseases, adverse birth outcomes, and a variety of other health impacts,” Buonocore says.
The state regulations were intended to speed the transition to cleaner vehicles to reduce air pollutants, and the Court’s green light to challenge the EPA rule will likely result in inequitable health consequences, he adds.
“Like all air pollution interventions, [the benefit of emission reductions] depends on where you are. [Communities] next to high-traffic roads, which are usually non-White, low-income, or otherwise marginalized populations, definitely present an environmental justice issue. Air quality issues in urban areas do tend to be largely driven by transportation, so EV deployment is a very useful strategy.”
Buonocore contributed to research demonstrating the benefits of electrification policies for reducing air pollution in New York City, but he is careful to note that EVs have trade-offs and still contribute to emissions through brake and tire wear and the generation of electricity to charge the cars. He urges that policy making process involve a cost-benefit analysis as well as a plan for tracking compliance and effectiveness after implementation.
“Many sources contribute to air pollution so the impacts of losing the ability to deploy EVs may not be readily visible,” says Buonocore. “[Policymakers should monitor] local air quality and hospital admissions for asthma, respiratory and cardiovascular disease.”
Mary Willis, assistant professor of epidemiology, has also conducted several studies on the potential health benefits of reducing air pollution. Her research shows that infant health outcomes are also associated with the toxicity of tailpipe emissions. However, Willis echoes Buonocore’s concern that due to their proximity to high-traffic areas, communities of color and lower-income neighborhoods often do not receive the same magnitude of benefits from emissions reductions.
“Many regulations around tailpipe emissions tout health benefits,” she says, “but we need to conduct empirical research to determine if the promised population health improvements were realized for the affected communities.”
