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With the Supreme Court’s 2023-24 term now complete, health care agencies and organizations are left grappling with a number of decisions impacting the administration of federal health programs and the delivery of emergency health care. Here are some of the big decisions from the Court’s past term that we have been watching.   Chevron Doctrine Overturned In a case seeming to have nothing to do with health care, the Court overturned a 40-year-old doctrine that made it easier for federal agencies to regulate industries in areas such as the environment, consumer protections, and workplace safety. The Chevron Doctrine required courts to defer to the reasonable interpretations of federal agencies when facing questions over ambiguous statutes passed by Congress. Some health policy experts say this decision could open the door for a flood of litigation on various health care regulations and shift the responsibility for deciding complex health care regulations from industry experts to the judicial system. It’s expected that the doctrine’s reversal will further exacerbate an already backlogged judicial system and slow legislation passing through Congress, as legislators must now account for all potential outcomes to prevent any ambiguity. The decision could also lead to disparate regulatory outcomes, as different Circuit Courts may differ in their opinions of federal regulations. Other organizations have applauded the decision, arguing that it “reaffirms the importance of checks and balances within our government. It ensures that agencies do not exceed their intended authority and that courts take a more active role in interpreting laws.” Some of the health care regulations expected to be litigated include the Food and Drug Administration’s approval of drugs such as Mifepristone (a drug commonly used in medical terminations of pregnancies) and some of the regulations implementing the No Surprises Act, which many congressional members argue has not been implemented as intended by Congress.   Statute of Limitations on Regulatory Rules Extended In another 6-3 decision, the Supreme Court ruled in favor of a business that opened in 2018 and was suing the Federal Reserve Board over a regulation issued in 2011. This decision allows entities to sue an agency over a regulation beyond the standard six-year statute of limitations. The entity suing must demonstrate that they were unable to sue during that period and prove they were harmed by the regulation. The six-year statute of limitations was imposed by Congress in its Administrative Procedure Act (APA), however, the APA did not clarify whether the six-year period begins when a regulation is issued or when a regulation begins to cause harm to an entity. In its ruling, the Court held that the six-year period begins when an entity is first harmed by a regulation. In its arguments, the Federal Reserve Board argued that such decision would deprive federal agencies and the entities they regulate of finality and regulatory consistency if cases can be brought against decades-old regulations. In her dissent, Justice Jackson warned that this decision, combined with the overturning of the Chevron Doctrine, could lead to a “tsunami of lawsuits.”   EMTALA and Reproductive Health Sent Back to Lower Courts In 2022, the U.S. Department of Justice (DOJ) brought a lawsuit challenging Idaho’s new law banning abortions even in emergency situations in which EMTALA applies. The District Court of Idaho issued an injunction while the case was being heard. This injunction was appealed by Idaho to the 9^th Circuit Court of Appeals, which ultimately reinstated it. Idaho then appealed the case to the U.S. Supreme Court, which initially agreed to take the case. The Supreme Court later decided that it shouldn’t have taken the case, restored the injunction, and sent the case back to the lower courts. The outcome of this judicial whiplash is that emergency abortions under EMTALA may continue in Idaho, at least for now.