Essential Coverage

by Jacob Outwin

On October 7, 2025, the U.S. Supreme Court heard oral arguments in Chiles v. Salazar.^[1] The case calls on the Court to decide whether Colorado’s ban on conversion therapy for minors violates a state-licensed counselor’s right to free speech.^[2]

Conversion therapy—clinically referred to as sexual orientation and gender identity change efforts (“SOCE”)—is an “attempt[] to change a person’s sexual orientation, gender identity, or related behaviors,” and this practice “stems from the scientifically discredited belief that being LGBTQ+ is a mental illness that should be cured.”^[3] There is broad consensus among professional associations calling for an end to SOCE, including the American Psychological Association (“APA”) and American Medical Association (“AMA”).^[4] The APA has noted that SOCE not only promotes the continued social stigmatization of members of the LGBTQ community, but it also lacks a scientific basis and leads to increased rates of depression, anxiety, and suicidality in individuals previously exposed to it.^[5]

The central issue presented in Chiles first appeared in the federal courts of appeals in 2014.^[6] Since then, a total of four circuits have taken up the issue and come to a variety of conclusions.^[7] The clearest point of contention between the courts of appeals concerns the appropriate level of scrutiny.^[8] The Ninth and Tenth Circuits have applied rational basis review to uphold bans,^[9] the Third Circuit has applied intermediate scrutiny to uphold a ban,^[10] and the Eleventh Circuit has applied strict scrutiny to strike down a ban.^[11] This disagreement makes sense because SOCE carried out through talk therapy does not appear to fit squarely within the categories of “conduct” or “pure speech.”

Given the shortcoming of existing doctrine, this blog argues that, in resolving the Chiles appeal, the Court should consider a clinical speech exception to the First Amendment to best balance states’ rights with individual liberties.

Continue reading ““Do No Harm” Unless Through Words? Defining a Clinical Speech Exception to the First Amendment”

by Joefred Uwaelue

The United States spends the most on healthcare globally, and leads the way for spending on prescription drugs compared to other nations in the Organization for Economic Co-operation and Development (“OECD”).¹ The steady increase in the cost of prescription drugs, which contributes to the rising cost of healthcare overall, explains why in 2018, the U.S. spent 256% more procuring prescription drugs compared to thirty-two other OECD nations combined.² The steady increase in the cost of procuring prescription drugs can be attributed to the fact that prescription drug prices have been increasing at a faster rate than inflation over the past decade.³ ​​After multiple unsuccessful legislative attempts to address the rapidly increasing prices of prescription drugs,⁴ Congress enacted The Inflation Reduction Act’s (IRA) Drug Negotiation Program (the Program) in 2022.⁵

The Program overrides the drug pricing model for Medicare Part B and Part D beneficiaries by granting the Secretary of HHS the authority to directly negotiate the price of selected prescription drugs and biologics with drug manufacturers.⁶ The Program’s negotiation process is comparable to established processes and practices for government procurement generally, which includes the processes and practices found in the Federal Acquisition Regulations (FAR).⁷ However, constitutional challenges have been brought by drug manufacturers against the Program’s provisions. These claims argue that the Program violates the Fifth Amendment Takings Clause, the First Amendment Free Speech Clause, and the Eighth Amendment’s prohibition on excessive fines.⁸ This blog will discuss the Fifth Amendment challenges to the Program, how the similarities between the Program’s provisions and the FAR play a role in determining the Program’s constitutionality, and the broader implications these challenges against the Program could have on government procurements more broadly.  

Continue reading “Government Contracts is the Answer: An Analysis into the Fifth Amendment Takings Challenge of the Inflation Reduction Act’s Drug Negotiations Program”

by Tarra Olfat

Imagine the following scenario—a pregnant woman enters a Medicare/Medicaid-participating emergency room with preeclampsia,^[1] threatening both the safety of the mother-to-be and her fetus. After screening the patient, the emergency room doctor determines that the best and most successful stabilizing treatment would be an abortion. Under the Emergency Medical Treatment and Labor Act, if the emergency medical situation falls within the purview of the statute, the doctor must stabilize the patient. However, state law prohibits abortions at all stages of pregnancy, unless the mother is at risk of imminent death.  Should the doctor follow state law and risk a less successful method of stabilization that could lead to serious injury to both the mother and the fetus? Or should the doctor follow federal law and perform the abortion, risking criminal indictment punishable by two to five years of prison time? The upcoming Supreme Court decision in Idaho v. United States will determine what the legally correct course of action would be.

Continue reading “EMTALA Post-Dobbs: Interpretations Lead to Emergent Issues and Could Lead to Unnecessary Deaths”

by Phoebe Fisher

Keisha Williams was incarcerated in the Fairfax County Adult Detention Center for six months. Although she is a transgender woman, she was placed in men’s housing, where she experienced harassment, intentional misgendering, and delays in her medical treatment.^[i] Williams brought suit under 42 U.S.C. § 1983^[ii] alleging that her experience while incarcerated violated the Americans with Disabilities Act (ADA), among other laws. In her complaint, Williams stated that she had gender dysphoria, and she argued that this constituted a disability under § 12102(1)(A) of the ADA.^[iii] In Williams v. Kincaid, the United States District Court for the Eastern District of Virginia, Alexandria Division dismissed her case on June 7, 2021.^[iv] Williams appealed to the United States Court of Appeals for the Fourth Circuit.^[v]

Continue reading “Will the Inclusion of Gender Dysphoria as an ADA-Protected Disability Improve Access to Gender-Affirming Healthcare?”

by Tom Romanchek

Not every drug that is researched and developed in the United States makes its way onto the shelves of your local drugstore. This is for good reason: to ensure that Americans may only access drugs with demonstrated efficacy in clinical trials that can safely treat a specified condition or illness.^[1] Safety and efficacy concerns can also create certain hurdles to promoting drug diversity and accessibility in the U.S. Limiting the drugs that make it through major clinical-research milestones and approval pathways reduces product variety and options for Americans. On the other hand, lowering safety and efficacy thresholds for introducing drugs into markets could pose greater risks and costs to consumers, but it may also incentivize innovation and greater investments in research from risk-averse pharmaceutical manufacturers.^[2] Competition between similarly effective drugs could also drive down product prices to the benefit of consumers.^[3] Yet, decreased safety and efficacy standards could lead to needless and increased marketing of drugs with little to no medical benefit, imposing greater costs on patients while incentivizing manufacturer-imposed limitations on drug innovation.^[4] In other words, there are clear tradeoffs between lax and stringent regulations. The Food and Drug Administration (FDA) considers these tradeoffs and imposes a controlled review process to limit the number of drug approvals each year. Whether the review is lenient or stringent in the end, the FDA universally cites safety and efficacy concerns under its statutory mandate^[5] as reasons for not certifying many drugs.^[6]

Continue reading “Drug Regulation or Innovation: A Comparative Look at the FDA and the CE Mark System”

by Chelsea Pardes

Every year, the United States Supreme Court hears blockbuster cases with massive societal implications that are evident to the public. But often, cases whose impact can be just as far-reaching fly under the radar. Health & Hospital Corp. of Marion County. v. Talevski is one such case. On its face, it seems to address only the narrow issue of nursing home care rights. In fact, its impact may undermine our system of providing access to social support program benefits for those in need.

Continue reading “A Quiet But Seismic Impact: Talevski May Deprive Individuals of Their § 1983 Right to Sue”