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Stephen Breyer on Health Care

Supreme Court Justice (nominated by Pres. Clinton 1994)


Broad authority for interstate commerce, like ObamaCare

In a case that may affect the healthcare overhaul, the justices vote 7 to 2 to give Congress 'broad authority' to enact all laws that are 'necessary and proper' to carrying out its constitutional power. The Supreme Court set a potential blueprint Monday for upholding the recently enacted healthcare law and its mandate that all Americans have insurance, saying Congress has a "broad authority" to pass laws that are "rationally related" to its constitutional aims.

The Constitution not only gives Congress the power to regulate interstate commerce, but the authority to enact all laws that are "necessary and proper" to carrying out this authority. The "choice of means" for carrying out its aims is left "primarily to the judgment of Congress," said Justice Breyer in US vs. Comstock. If Congress has a delegated power, such as over interstate commerce, it may regulate it in a way that infringes on the state's authority.

Source: David Savage, Los Angeles Times, "Sex offendors" , May 15, 2010

Allow states to restrict cigarette ads beyond federal rules

The Supreme Court handed the tobacco industry a major victory over state efforts to restrict tobacco advertising, striking down Massachusetts regulations that would have banned such advertising near playgrounds and schools. Massachusetts had argued that the rules were necessary to prevent tobacco makers from inducing children to try a highly addictive and hazardous substance. But the court, dividing 5 to 4, agreed with the industry that the state could not adopt restrictions on top of those imposed by federal law. In addition, the court said, the rules infringed on freedom of speech.

The court’s decision effectively prevents state and local governments from unilaterally adding regulations on cigarette advertising, as many have attempted to do in recent years. Justice O’Connor wrote-with Rehnquist, Scalia, Kennedy, and Thomas concurring-that federal law “places limits on policy choices available to the States.” The cases are Lorillard v. Reilly, 00-596, and Altadis USA v. Reilly, 00-597.

Source: Charles Lane, Washington Post, p. A1 , Jun 29, 2001

States have authority to protect patient rights.

Justice Breyer joined the Court's decision on Rush Prudential HMO v. Moran on Jun 20, 2002:

Petitioner Rush Prudential HMO, Inc. provides medical services for employee welfare benefits plans covered by the Employee Retirement Income Security Act (ERISA), denied respondent Moran's request to have surgery on the ground that the procedure was not medically necessary. Moran made a written demand for an independent medical review of her claim, as guaranteed by Illinois' HMO Act. Rush refused her demand

HELD: Delivered by Souter, joined by Stevens, O'Connor, Ginsburg, Breyer

In 5-4 decision, justices uphold Illinois state law that requires health maintenance organizations to provide for independent review in disputed cases where physician-prescribed treatment is being denied by HMO. Although Congress has yet to enact a patients' bill of rights that would include the right to independent review, 42 states and the District of Columbia currently have medical review laws. Congress has long recognized that HMOs are risk-bearing organizations subject to state regulation. Finally, allowing States to regulate the insurance aspects of HMOs will not interfere with the desire of Congress for uniform national standards under ERISA.

DISSENT: Dissent by Thomas, joined by Rehnquist, Scalia, Kennedy

This Court has repeatedly recognized that ERISA's civil enforcement provision provides the exclusive vehicle for actions asserting a claim for benefits under health plans governed by ERISA, and therefore that state laws that create additional remedies are pre-empted. Such exclusivity of remedies is necessary to further Congress' interest in establishing a uniform federal law of employee benefits so that employers are encouraged to provide benefits to their employees. Independent review provisions could create a disincentive to the formation of employee health benefit plans. This is a judgment that must be made by Congress. I respectfully dissent.
Source: Supreme Court case 02-MORAN argued on Jan 16, 2002

Federal government decides insurance issues, not states.

Justice Breyer wrote the dissent on Empire HealthChoice Assurance v. McVeigh on Jun 15, 2006:

A 5-4 Court decided that federal jurisdiction does not extend to controversies over insurance contracts under the Federal Employees Health Benefits Act. Thus, state courts are the proper venue for contract disputes arising between federal employees and insurance companies, which may result in inconsistent outcomes across states.

Empire Healthchoice Assurance sued the estate of a deceased federal employee who received $157,000 in insurance benefits as the result of an injury. The wife of this federal employee had won $3.2 million in a separate lawsuit; Empire Healthchoice claimed reimbursement because the beneficiary was compensated for the same injury by a third party.

HELD: Ginsburg, joined by Roberts, Stevens, Scalia, and Thomas

The Court ruled that under the Federal Employees Health Benefits Act, state courts, not federal courts, are the proper forum for a contracts lawsuit by a plan administrator seeking reimbursement for medical costs. Empire, the Court ruled, had not demonstrated a "significant conflict between an identifiable federal policy or interest and the operation of state law."

DISSENT: Breyer, joined by Kennedy, Souter, and Alito

The dissenting opinion asserted that the dispute should have been deliberated at the federal level because, in part, "there is little about this case that is not federal."

ORIGINAL HOLDING: Sotomayor

Judge Sotomayor, then on the Second Circuit prior to her Supreme Court nomination, found no federal jurisdiction because Empire failed to show that New York state law "significantly conflicts" with federal interests. The Supreme Court affirmed Sotomayor's decision.
Source: Supreme Court case 06-MCVEIGH argued on Apr 25, 2006

Congress did not intend disparate result on generic drugs.

Justice Breyer joined the concurrence on PLIVA v. MENSING on Jun 23, 2011:

Plaintiffs were prescribed a brand name drug for which pharmacists substituted a generic drug, which the FDA had approved under the process federal law authorized for generics. Plaintiffs were diagnosed with a disorder linked to the extended use of the drug. They filed state tort law claims against the manufacturers of the generics, alleging failures to label their products with a warning of known risks. The generics carried the same warnings as the brand name and, the manufacturers argued, since federal regulations required the generics to have the same warnings as the brand name, compliance with a state law requiring different warnings was impossible.

HELD: Delivered by Thomas; joined by Roberts, Scalia, Kennedy & Alito

Generic manufacturers were forbidden to change unilaterally the label warning of the drug. Plaintiffs argued that the manufacturers could have complied with both state and federal law by following the process federal regulations set out of proposing stronger warnings to the FDA (which they did not), after which the FDA might have decided to negotiate a label change with the brand name manufacturer that the generic manufacturers would have been required to adopt. The Court found that
  1. state law required a stronger warning
  2. federal law prohibited a stronger warning, and
  3. requesting the FDA to authorize a stronger warning
was not enough to comply with state law requiring a stronger warning. Federal and state laws conflict when it is impossible to do what both laws require. It was impossible for the generic manufacturers to comply with both laws. Since federal law preempts conflicting state law, the manufacturers may not be sued on these state law claims.

DISSENT: Sotomayor dissents; joined by Ginsburg, Breyer & Kagan

Congress could not have intended the result that brand name drug consumers may sue manufacturers for failure to warn, while the much larger class of generic drug consumers may not.
Source: Supreme Court case 11-PLIVA argued on Mar 30, 2011

Other Justices on Health Care: Stephen Breyer on other issues:
Samuel Alito
Stephen Breyer
Ruth Bader Ginsburg
Elena Kagan
Anthony Kennedy
John Roberts
Antonin Scalia
Sonia Sotomayor
Clarence Thomas

Former Justices:
David Souter
Sandra Day O'Connor
William Rehnquist
John Paul Stevens

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Page last updated: Jul 12, 2013