Justia U.S. 9th Circuit Court of Appeals Opinion Summaries

Plaintiffs, a class of economically vulnerable Arizonians who receive public health care benefits through the state's Medicaid agency, sued the U.S. Secretary of Health and Human Services (Secretary) and the Director of Arizona's medicaid agency (director)(collectively, defendants), alleging that the heightened mandatory co-payments violated Medicaid Act, 42 U.S.C. 1396a, cost sharing restrictions, that the waiver exceeded the Secretary's authority, and that the notices they received about the change in their health coverage was statutorily and constitutionally inadequate. The court affirmed the district court's conclusion that Medicaid cost sharing restrictions did not apply to plaintiffs and that Arizona's cost sharing did not violate the human participants statute. The court reversed the district court insofar as it determined that the Secretary's approval of Arizona's cost sharing satisfied the requirements of 42 U.S.C. 1315. The court remanded this claim with directions to vacate the Secretary's decision and remanded to the Secretary for further consideration. Finally, the court remanded plaintiffs' notice claims for further consideration in light of intervening events.

This case arose when the Washington State Department of Health (Department) would not license Yakima Valley Memorial Hospital (Memorial) to perform certain procedures known as elective percutaneous coronary interventions (PCI) where, according to the Department, the community Memorial served did not need another PCI provider. The district court held that Memorial failed to state a claim of antitrust preemption, holding that the PCI regulations were a unilateral restraint on trade not barred by the Sherman Act, 15 U.S.C. 1-7. With regard to Memorial's claims under the dormant Commerce Clause, the district court found Memorial had standing because it alleged it would participate in an interstate market for PCI patients, doctors, and supplies. Nevertheless, the district court found that any burden on Memorial's interstate commercial activity was expressly authorized by Congress' approval of certificate of need regimes, making a dormant Commerce Clause violation impossible. The court agreed that Memorial failed to state a claim of antitrust preemption because the PCI regulations were a unilateral licensing requirement rather than an agreement in restraint of trade. The court also agreed that Memorial had standing under the dormant Commerce Clause, but reversed the district court's judgment on that claim because the Department failed to prove congressional authorization for the PCI regulations.

Steve Baldwin and the Pacific Justice Institute challenged the constitutionality of the so-called "individual mandate" provision in the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119, which would take effect in 2014. Baldwin objected to this provision but failed to allege that he did not have qualifying health insurance or that he would not have it in 2014. The Institute also objected but failed to allege that the "individual mandate" applied to it or that it had enough employees to be subject to the analogous "shared employer responsibility" provision. Therefore, neither Baldwin nor the Institute had shown injury in fact, or a genuine threat of prosecution, sufficient to give them standing or making their challenge justiciable. Accordingly, the court affirmed the district court's dismissal of the complaint.

In consolidated appeals, defendants appealed the denial of their motions for judgment on the pleadings where plaintiffs brought a diversity suit to enforce California Civil Code 2527 and 2528, which required defendants to supply the results of bi-annual studies of California's pharmacies' retail drug pricing for private uninsured customers to their clients, who were third-party payors such as insurance companies and self-insured employer groups. At issue was whether the court was bound by the Erie doctrine to follow the state appellate court decisions striking down section 2527 and if not, whether section 2527 violated the First Amendment or the California Constitution's free speech provision. The court held that the Erie doctrine did not require it to follow the state appellate court decisions and that section 2527 did not unconstitutionally compel speech under either the United States or California Constitutions. Accordingly, the court affirmed the judgment.

Appellant, a medicare provider, appealed its notice of program reimbursement for the fiscal year ending in 2001 to the Provider Reimbursement Review Board ("Board"), which dismissed the appeal because appellant missed its deadline to file a preliminary position paper. After the Board denied appellant's motion for reinstatement of its appeal, appellant filed the current action and subsequently appealed from the district court's order granting summary judgment for appellee. The court affirmed summary judgment and held that the Board's Instructions requiring dismissal of claims due to failure to timely submit preliminary position papers did not violate the Medicare Act, 42 U.S.C. 1395, and the Board's dismissal of appellant's claim was neither arbitrary or capricious.

Plaintiff applied at age 51 for supplemental security income based on disability. At issue was whether the administrative law judge ("ALJ") erred by failing to develop the record adequately and should have requested more explanation from two of plaintiff's treating physicians at the Department of Veterans Affairs ("VA"). The court held that the ALJ's failure to assist plaintiff in developing the record by getting his disability determination into the record was probably likely to have been prejudicial because the court gave VA disability determinations great weight. Therefore, the court remanded under sentence four of 42 U.S.C. 405(g), concluding that "the agency erred in some respect in reaching a decision to deny benefits."

Plaintiffs, two non-profit organizations, sought injunctive and declaratory relief to remedy the delays in the provision of mental health care and adjudication of service-connected death and disability compensation claims by the Department of Veterans Affairs ("VA"). At issue was whether these delays violated veterans' due process rights to receive the care and benefits they were guaranteed by statute for harms and injuries sustained while serving our country. While the court affirmed the district court's ruling, with respect to various claims for specific forms of relief under the Administrative Procedures Act ("APA"), 5 U.S.C. 500 et. seq., that the APA prevented the court from granting veterans the statutory relief they sought, the court reversed the district court's ruling on plaintiffs' constitutional claims and held that the VA's failure to provide adequate procedures for veterans facing prejudicial delays in the delivery of mental health care violated the Due Process Clause of the Fifth Amendment. The court further held that the district court erred in concluding that it lacked jurisdiction to review plaintiffs' due process challenge to delays and procedural deficiencies in the compensation claims adjudication system and that it erroneously denied plaintiffs' the relief to which they were entitled under the Due Process Clause.