Healthcare cases to watch in Trump's second term

By Brendan Pierson

Dec 26 (Reuters) - When Republican President-elect Donald Trump takes office for the second time next year, he will inherit a slew of lawsuits challenging the Biden administration's healthcare policies. The cases will give him an immediate opportunity to change course, before any new rules or legislation are passed, and could offer an early look at his administration's approach. Here are some of the cases to watch.

ABORTION

Many of the most closely watched lawsuits have centered on abortion rights in the wake of the U.S. Supreme Court's 2022 ruling allowing states to ban abortion. Trump shied away from offering specific policies on abortion during his campaign, but his administration will need to take positions in several pending cases.

In one case, three Republican-led states are seeking to restrict the distribution of the abortion pill mifepristone. The U.S. Food and Drug Administration under Biden has defended loosening restrictions on the drug in recent years but could reverse course under Trump.

Another case involves abortions in medical emergencies. The Biden administration sued Idaho in 2022, alleging that the state's near-total abortion ban runs afoul of the federal Emergency Medical Treatment and Labor Act, which requires hospitals to stabilize patients in medical emergencies, by potentially preventing medically necessary abortions.

The administration won a court order barring Idaho from enforcing its abortion ban in medical emergencies, which the U.S. Supreme Court has left in place for now. Idaho is appealing, and the case was argued in December before an en banc panel of the 9th U.S. Circuit Court of Appeals with a majority of conservative judges.

Should the court rule against the administration, it would give Trump the chance to abandon the Biden administration's stance on the law rather than appealing, allowing Idaho's law to be enforced.

DRUG PRICING

One of Biden's signature policies, part of the Inflation Reduction Act of 2022, requires drug companies to negotiate with Medicare over the prices of some drugs. The measure has faced numerous lawsuits from the industry, most of which have failed at the trial court level - although one was recently revived by the 5th Circuit.

The industry is pushing Trump and the incoming Republican majority to tweak the law's implementation, by allowing companies to enjoy a longer period of guaranteed market exclusivity for new drugs before they become eligible for negotiation.

While observers do not expect Trump to attempt a wholesale repeal of the program, his administration will immediately be faced with a choice of whether to defend every aspect of it, including its deadlines and hefty penalties, in court. If he does not do so, it could make it more likely that courts will chip away at the program.

PREVENTIVE CARE

Since Biden took office, his administration has been defending against a 2020 lawsuit by Christian-owned businesses in Texas challenging the Affordable Care Act's requirement that health insurance plans cover preventive care services, including cancer screenings, certain vaccines, and pre-exposure prophylaxis against HIV.

The 5th Circuit ruled earlier this year that the U.S. Department of Health and Human Services could continue enforcing the mandate for now but that the method it has used to select which services must be covered is unconstitutional, leaving the future of the coverage in doubt.

But it is not clear how Trump's administration will approach the case - particularly in light of Trump's pick of Robert F. Kennedy Jr, a longtime vaccine opponent, as his nominee for Secretary of Health and Human Services. Major medical groups have warned that without the coverage mandate, public health could suffer.

HEALTHCARE FOR TRANSGENDER MINORS

One Biden administration lawsuit over healthcare for transgender minors, challenging a Tennessee law banning them from receiving gender transition treatments like puberty blockers and hormones, is already set to be decided by the U.S. Supreme Court.

Another case, however, remains pending over a rule finalized earlier this year by HHS forbidding recipients of federal Medicare and Medicaid funds from discriminating on the basis of gender identity. A federal judge temporarily blocked the rule from taking effect in response to a challenge by Republican states.

Trump has criticized the Biden administration's approach to transgender issues and rolled back similar protections in his first term. Rescinding the rule altogether would take time, but Trump's HHS could stop defending it in court immediately.

NURSING HOME STAFFING

Earlier this year, the Biden administration announced new rules on staffing for nursing homes that receive Medicare and Medicaid funding, following a promise to crack down on abuse and neglect of nursing home patients.

The new rule, which is set to be phased in over several years, will require nursing homes to have a registered nurse on duty 24 hours per day, and total nurse staffing of at least 3-1/2 hours per resident per day. Federal law previously required nursing homes to employ a registered nurse for eight consecutive hours per day.

Industry groups and a group of Republican attorneys general have sued the administration over the rule, saying that it does not take into account a nationwide nurse shortage and that rural nursing homes could be driven out of business because they cannot comply.

Trump and the incoming Republican majority are widely expected to scrap the rule, which is opposed by some Democrats as well. It could signal its intentions immediately by dropping its defense of the cases, clearing the way for a swift rollback.

(Reporting By Brendan Pierson in New York)