journalfront

Medical Care

The Supreme Court's U.S. v. Skrmetti: Trans Healthcare on the Line

2024-11-27

In a significant legal development, the Supreme Court is set to hear oral arguments in the case of U.S. v. Skrmetti on December 4. This case holds great importance as it challenges Tennessee's ban on healthcare for trans youth. The courtroom will witness a historic moment as it is the first of its kind to be heard by the nation's highest court, potentially setting a crucial precedent for future trans rights cases.

The Supreme Court's Decision in U.S. v. Skrmetti: A Turning Point for Trans Rights

Background and Context

An activist holds a sign calling for federal protections of transgender rights in front of the U.S. Supreme Court on April 1, 2023. This event serves as a backdrop to the upcoming case. 2024 marks a unique year as it is the first time in several years that the Supreme Court will not hear a significant case directly related to abortion rights. However, the question of bodily autonomy remains on the docket.The plaintiffs in U.S. v. Skrmetti are Samantha and Brian Williams, of Nashville, along with their 15-year-old trans daughter L.W. and two other anonymous families. Represented by various legal organizations, they have filed suit against the state of Tennessee and its attorney general Jonathan Skrmetti to block the ban. Chase Strangio, the co-director for transgender justice with the ACLU's LGBT & HIV Project, will be representing the clients.L.W. expressed her feelings, saying, "I don't even want to think about having to go back to the dark place I was in before I was able to come out and access the care that my doctors have prescribed for me. I want this law to be struck down so that I can continue to receive the care I need, in conversation with my parents and my doctors, and have the freedom to live my life and do the things I enjoy."The Tennessee law in question took effect last summer after an appeals court denied the plaintiffs' request for an injunction. The plaintiffs argue that the ban violates the U.S. Constitution's Equal Protection Clause, similar to the argument made in 2020's Bostock v. Clayton County.

Legal Implications and Precedents

Legal experts have drawn parallels between Skrmetti and Dobbs v. Jackson, which overturned Roe v. Wade in 2022. Both cases involve prohibitions on medical treatments vital to a subset of the population. Conservative attorneys are arguing that the Constitution's protections do not apply, and in both cases, conservatives are using the regulation of a medical procedure to target a particular group and circumscribe their autonomy.Since 2021, 24 states have passed laws banning gender-affirming care for trans youth. However, every major medical organization in the U.S. and leading world health authorities support and consider gender-affirming health care for trans youth to be the best practice.Lambda Legal chief legal officer Jennifer C. Pizer stated, "The stakes could not be higher for our communities as the Supreme Court prepares to hear oral argument in U.S. v. Skrmetti and L.W. v. Skrmetti. As hostile state leaders prepare to double-down on their cruel, unprecedented and discriminatory attacks on transgender youth, the Court has the opportunity and duty to apply the law fairly, which means returning medical decisions to where they rightfully belong: to parents, their children and their doctors."This case is not only about the fate of a specific ban but also about the broader issue of transgender rights and the role of the Supreme Court in safeguarding them. It has the potential to shape the legal landscape for years to come and ensure that transgender individuals have access to the healthcare they need.

Tim Barry, the former chief executive officer of VillageMD, has stepped down from his positions. This significant development comes as the clinic operator has faced challenges and incurred billions of dollars in losses for its majority owner, Walgreens Boots Alliance. VillageMD's statement confirmed Barry's departure and appointed Chief Operations Officer Jim Murray as the interim CEO to ensure a smooth transition and continuity of care.

Unraveling the Impact of Tim Barry's Exit on VillageMD

VillageMD's Struggles and Expansion Setbacks

VillageMD, founded in 2013 by Tim Barry, initially showed great promise. However, since then, it has struggled to fill its clinics attached to Walgreens with patients. The company has scaled back dramatically on the expansion of doctor practices it manages and the opening of Village Medical clinics. This has led to significant losses for Walgreens and a need to reevaluate the investment.The initial plans to open 500 to 700 "Village Medical at Walgreens" physician-led primary care clinics over five years did not materialize as expected. The challenges in attracting patients and managing the expansion have had a profound impact on the company's growth and profitability.

Jim Murray's Background and Role in the Turnaround

Jim Murray joined VillageMD in April, bringing with him a wealth of experience from the healthcare industry. His background includes executive roles at health insurers like Centene and Magellan Health, as well as Humana, which has a large Medicare health benefits business.Since joining VillageMD, Murray has been integral in helping lead the company's turnaround. His experience and leadership skills have been crucial in positioning the company for profitable growth. As the interim CEO, he is now responsible for day-to-day leadership and ensuring the smooth operation of the clinics.

Walgreens' Perspective and Future Plans

Walgreens has been facing its own challenges and has been looking to reduce its investment in VillageMD. The billions of dollars in losses and the need to focus on more profitable ventures have led to a reevaluation of the partnership.However, Walgreens remains committed to keeping VillageMD, Summit Health, and CityMD doctors, team members, and patients top of mind. The company is focused on building trusted relationships that create healthier futures for all stakeholders.In June, Walgreens CEO Tim Wentworth indicated that the company would remain an investor and partner but is working towards an endpoint. This suggests that there may be further changes and decisions in the future regarding the VillageMD partnership.The total operating loss for the first nine months of fiscal 2024 grew to more than $13 billion, with a significant non-cash impairment charge related to VillageMD goodwill. This highlights the financial challenges faced by both VillageMD and Walgreens and the need for strategic decisions to address them.

Managed Healthcare Executive editors had the opportunity to engage with Paul Fronstin, the director of Health Benefits Research at EBRI. They delved into the various trends in health plan benefit design and explored the significance of high-deductible health plans and HSAs.

Challenges Faced by Employers

Employers encounter difficulties in motivating the utilization of high-value healthcare while effectively managing costs. As noted by Fronstin, there is a need to find ways to incentivize the use of high-value providers, yet achieving this balance has proven to be a challenge. For instance, the IRS's 2019 decision to make certain preventive services like insulin covered before deductibles led to 75% of employers promptly adopting at least one of these services. This shows the potential impact of such decisions on employer behavior.

It is clear that employers are constantly striving to strike a balance between providing quality healthcare and controlling costs. The ability to incentivize the right behaviors is crucial in this regard.

Impact of High-Deductible Health Plans and HSAs

Regarding high-deductible health plans and HSAs, Fronstin pointed out that higher deductibles initially lead to a decrease in healthcare utilization. However, over time, this usage stabilizes. He also compared the differences between the impact of HSAs and deductibles, highlighting their unique characteristics.

HSAs offer the potential for long-term savings, but many people currently use them to cover immediate healthcare costs. This shows the need for better education and understanding of how HSAs can be utilized effectively.

Recent Studies and Preventive Care

Recent studies have revealed an interesting trend. When certain drugs were removed from deductibles, there was a slight increase in medication adherence. This emphasizes the importance of accessible preventive care and how it can have a positive impact on patient outcomes.

It is evident that these findings have significant implications for the future of healthcare. By making preventive care more accessible, we can potentially improve overall health and reduce healthcare costs in the long run.