Supreme Court pauses order requiring Trump administration to rehire probationary workers

The Supreme Court on Tuesday paused an order from a lower-court judge that would require the Trump administration to rehire around 16,000 fired probationary employees.

U.S. District Judge William Alsup last month ruled that the Office of Personnel Management lacked the legal authority to direct mass firings at other agencies. The U.S. Court of Appeals for the Ninth Circuit in San Francisco declined to pause Judge Alsup's order while the government pursued an appeal.

In an emergency application asking the Supreme Court to intervene, acting solicitor general Sarah Harris said that federal judges have issued more than 40 temporary restraining orders or injunctions blocking various administration programs, and many of them involved rulings that applied nationwide.

"The court's extraordinary reinstatement order violates the separation of powers, arrogating to a single district court the executive branch's powers of personnel management on the flimsiest of grounds and the hastiest of timelines," Harris wrote. "That is no way to run a government. This court should stop the ongoing assault on the constitutional structure before further damage is wrought."

The Supreme Court ruled 7-2 that Alsop's order, which had been based on allegations from nine nonprofit groups, was improper as the groups didn't have standing to sue, meaning they didn't have a direct stake in the firings and couldn't bring legal action. The court's order didn't address allegations brought by workers' unions that are also part of the lawsuit.

Justices Sonia Sotomayor and Ketanji Brown Jackson dissented, saying they would have denied the government's application to pause the rehirings while litigation continues.

The majority opinion stated that Alsup's injunction "was based solely on the allegations of the nine non-profit-organization plaintiffs in this case. But under established law, those allegations are presently insufficient to support the organizations' standing."

The stay will remain in place until the case is decided by the U.S. Court of Appeals for the Ninth Circuit and the plaintiffs decide whether to bring any appeal of that ruling to the Supreme Court.

(Jouvenal, Washington Post, 4/8; Liptak, New York Times, 4/8)

RFK Jr. calls for ban on fluoridated drinking water

HHS Secretary Robert F. Kennedy Jr. on Monday called for states to ban fluoride in drinking water supplies. The announcement came at a news conference in Utah, which recently became the first state to enact a ban on fluoride in drinking water.

"It makes no sense to have it in our water supply," Kennedy said. "I'm very, very proud of this state for being the first state to ban it, and I hope many more will come."

Most Americans drink fluoridated water, and CDC has for many years recommended small amounts of fluoride be added to community water systems to prevent cavities. CDC has also listed water fluoridation as one of the 10 great public health achievements of the 20th century. The American Dental Association has said that water fluoridation reduces dental decay by at least 25% in children and adults.

However, Kennedy has decried the practice, calling fluoride a "dangerous neurotoxin" and alleging that fluoride can harm brain development and bones and lead to arthritis and thyroid disease. Some studies have suggested these links could exist, typically at higher-than-recommended fluoride levels, however some reviewers have questioned the quality of available evidence and have said no definitive conclusions can be drawn.

In an email on Monday, HHS said it "is reconvening the community preventative services task force to study and make a new recommendation on fluoride" and Kennedy also said he intends to tell CDC to stop recommending water fluoridation in communities.

In addition, the U.S. Environmental Protection Agency (EPA) on Tuesday said it plans to "expeditiously review new scientific information on potential health risks of fluoride in drinking water."

"Secretary Kennedy has long been at the forefront of this issue. His advocacy was instrumental in our decision to review fluoride exposure risks and we are committed to working alongside him, utilizing sound science as we advance our mission of protecting human health and the environment," said EPA Administrator Lee Zeldin.

(Kaur, Washington Post, 4/8; Nunn, New York Times, 4/8; Schoenbaum/Stobbe, Associated Press, 4/7; EPA press release, 4/7)

CMS also plans to finish phasing-in its MA risk adjustment model and continue its approach for removing medical education costs from expenditures when calculating growth rates.

Ceci Connolly, president and CEO of the Alliance for Community Health Plans (ACHP) commended the Trump administration "for finalizing policies in the [rate notice] that reflect higher care delivery costs and for taking another step toward reining in aggressive risk adjustment to boost competition. ACHP has long supported the new MA risk adjustment model and is pleased that CMS will finally complete the transition."

(Herman, STAT+ [subscription required], 4/7; Tong, Fierce Healthcare, 4/8) (Karins/Brown, Inside Health Policy [subscription required], 4/4)

Senate confirms Dr. Oz as CMS Administrator

The Senate last week confirmed Mehmet Oz in a 53-45 party line vote to serve as CMS Administrator, placing him in charge of overseeing more than $1 trillion in annual government spending.

Oz has long been a vocal proponent of MA, previously promoting it on his TV show and acting as a broker for a company that sells MA plans. At his confirmation hearing before the Senate Finance Committee, Oz appeared to acknowledge problems with MA and reassured senators that there was a "new sheriff in town."

As head of CMS, Oz said he will focus on HHS Secretary Robert F. Kennedy Jr.'s agenda to "Make America Healthy Again" by focusing on preventive care.

"The deeper promise that we should all be making to America is we're going to make it easy for America to do the right thing when it comes to their health," Oz said at his confirmation hearing.

According to Anand Parekh, chief medical adviser at the Bipartisan Policy Center, Oz has a chance to improve America's health with investments in preventive, primary, and value-based care.

"If CMS wanted to be, they could be the most important prevention agency at HHS," Parekh said, adding there are ways officials could invest in saving money on preventing elder adult falls or focusing on chronic care services.

Joan Alker, executive director and cofounder of the Center for Children and Families at Georgetown University, said there's plenty of reform for Medicaid that "can and should be done" but cautioned against a "sledgehammer" approach for Oz.

"Mistakes are very consequential for the folks who rely on Medicaid, often for life-and-death services," she said.

(Abelson/Craig, New York Times, 4/3; Weber, Washington Post, 4/3)

Federal judge strikes down nursing home staffing mandate

A federal judge on Monday blocked a federal nursing home staffing mandate rolled out by former President Joe Biden last year.

U.S. District Court for the Northern District of Texas Judge Matthew Kacsmaryk said in his decision that HHS didn't have the authority to go beyond laws passed by Congress regarding nursing home staffing. He also said that CMS could not require nursing homes to have a registered nurse on staff 24 hours a day, seven days a week or require them to provide a minimum of 3.48 hours of nursing care per resident, per day.

"Though rooted in laudable goals, the Final Rule still must be consistent with Congress's statutes," Kacsmaryk wrote in his decision. "To allow otherwise permits agencies to amend statutes though they lack legislative power. Separation of powers demands more than praiseworthy intent."

The American Health Care Association (AHCA), the nursing home trade group that filed the lawsuit, said Kacsmaryk's decision was a victory for nursing homes, their residents, and families.

"This unrealistic staffing mandate threatened to close nursing homes and displace vulnerable seniors," said Clifton Porter, AHCA president and CEO. "The court decision not only upholds the rule of law and balance of powers, but it protects access to care for our aging population."

(Eastabrook, Modern Healthcare, 4/7)