The athlete’s physique is both a marvel and a weapon. Witness Killian Maddox, a bodybuilder whose formidable muscles gleam under golden light. He is a violent man—some might even say “disturbed”—whose chosen profession leads him to use performance-enhancing drugs that further amplify his aggression. Maddox does not make vague threats toward people who run afoul of him. Instead, he specifically tells them that he will split their skull apart and drink their brains like soup—a promise he makes twice over the run of Magazine Dreams, a new movie by the writer-director Elijah Bynum.
For much of the film, Maddox, who is played by Jonathan Majors, does not seem capable of acknowledging his capacity for violence. This dismissive attitude would be unnerving in any dramatic character study, but unlike earlier cult classics about angry men in search of belonging, Magazine Dreams comes with a different context. The movie has been mired in controversy since shortly after it first debuted to a standing ovation and positive reviews at the Sundance Film Festival in January 2023, when Majors was a rapidly rising star. Two months later, he was arrested and charged with assault and harassment following a dispute with his then-girlfriend, the actor Grace Jabbari. Majors denied the allegations, but Magazine Dreams was dropped by its original distributor amid the fallout. And within the year, a jury had found him guilty on two of four charges—one harassment violation and one misdemeanor assault charge. The Magazine Dreams release seemed uncertain until last October, when it was acquired by Briarcliff Entertainment, the distributor behind the Donald Trump biopic The Apprentice.
Ahead of the movie’s delayed release, Majors has attempted to re-ingratiate himself with Hollywood decision makers and the viewing public, dominating the Magazine Dreams press run with interviews that emphasize his personal growth. The PR blitz draws attention to an uncanny parallel with his character. Magazine Dreams is a film about a man who constantly puts himself on display for others to judge: All Maddox wants is to be the best bodybuilder alive. But sheer athleticism won’t turn him into a celebrity, and his demeanor doesn’t endear him to people—Majors plays Maddox as a sullen and tightly wound outcast whose environment shapes his isolation. The athlete is not just socially inept; in several scenes, he either deliberately misleads or aggresses people who do attempt to engage him.
Whereas the character fails to earn the admiration of those around him, the embattled actor is trying to prove that he can do it successfully in real life. The Magazine Dreams press run has seen Majors portraying himself as a flawed but fundamentally good man who can transcend his past misbehavior. Several high-profile celebrities have come forward to say that they have faith in him as an actor and a man; in interviews, Majors has spoken about leaning on religion, and he sports a new tattoo that reads rebirth. And a week before the film’s theatrical release, The Hollywood Reporter published a cover story in which Majors was asked what he would say to entertainment-industry figures now, as he looks to rebuild a once-promising career. “I would tell them I’m still learning,” the actor said, “and I would thank them for participating in my growth.”
Although some of these features do quote dissenting voices, the stories have largely positioned Majors as a fallen man who just might deserve to reclaim his mantle—someone who, perhaps, has suffered enough already. If this redemptive rhetoric feels familiar, it’s because several other men have tried to stage industry comebacks using similar language. “They’re using all the hot-button words,” one crisis-communications consultant said of Majors’s team in an interview with New York magazine. A supporting cast of women has also helped burnish Majors’s image, in part by reinforcing the actor’s view of himself as an important pillar of the Black community—the kind of charismatic male leader we all need. Majors has repeatedly denied any allegations of violence against women, but last month, Rolling Stone reported on an audio recording in which Majors appears to admit to strangling Jabbari. When asked by Complex how he felt about the audio emerging so close to the film’s release, Majors defaulted to platitudes: “There were vibrations, reverberations, same as everything before,” he said. “But I was happy I’d done my work. I was happy I’d done my work.”
The spectacle of Majors’s redemption tour has certainly overshadowed the work of the Magazine Dreams creative team and crew, as well as that of the rest of the cast. Ironically, the film is at its most compelling when it explores the deadly implications of male entitlement. The question that hangs over the screenplay is not if Maddox’s desolation will metastasize into violence, but when. Maddox struggles to connect with nearly everyone around him, especially women: When other characters ask him about himself, he either becomes tongue-tied, deflects the questions, or responds with an overwhelming barrage of information.
A date with his grocery-store co-worker, a cheerful young white woman who seems genuinely interested in him, ends on a sour note after he scares her off with an eerily matter-of-fact description of his parents’ deaths. (Maddox’s father killed his mother, and then himself.) Two uneasy sexual encounters leave him even more adrift: In one of them, a Black sex worker chastises Maddox for kissing her; the woman’s contempt, coupled with his own steroid-induced erectile dysfunction, induces palpable shame. Before the scene abruptly ends, it feels fraught with the clichéd possibility of Maddox unleashing his rage on the woman. As the story progresses, we watch as rejection or perceived disrespect plunges Maddox further into a spiral that seems destined to end with bloodshed, whether realized or simply threatened. Magazine Dreams is not always deft or subtle in its approach, but it does attempt to seriously dig into weighty, complicated material.
And yet, Majors’s press run suggests a distance between the actor and some of the film’s core elements—a blind spot that distracts from the work itself. In an interview with Variety, Majors responded to a comment about Maddox’s crushing solitude and the on-screen violence by asking where the reporter sees violence in the film. (There are several such scenes in Magazine Dreams, and some involve Majors’s face and body being covered with blood; after the journalist cited some, Majors clarified that he believes audiences have the right to perceive art as they see fit.) As Magazine Dreams progresses, Maddox descends further into his antisocial tendencies and grows more destructive. Majors has argued that this kind of behavior stems primarily from loneliness: In the Variety interview, he said that society uses “positive-sounding attributes” such as “lone wolf” and “Alpha male” to describe toxic masculinity, making it difficult for men—once they are on their own—to “get back without help.”
But Magazine Dreams doesn’t revolve around a character who’s simply been abandoned by nearly everyone. The film depicts a man whose ego isolates him and prevents him from forging genuine bonds—who pushes people away with his obfuscation, lies, and single-minded pursuit of fame through physical strength. Even before he commits any violence, Maddox conveys an inability to see himself as more than his body, or to accept any response from the outside world but praise. In that sense, the question of separating Majors, or his conviction, from the movie he headlines feels like a moot one. For some viewers with knowledge of his off-screen reputation, watching Majors radiate quiet hostility in Magazine Dreams may already make the all-consuming performance difficult to evaluate in a vacuum. And even for those who might be able to separate art from artist, the actor’s seeming lack of introspection about how violence is threaded through his film is an artistic failing. No training regimen can compensate for that.
Less than a month before his assassination in 1963, President John F. Kennedy signed his last bill: one aimed at reforming America’s mental-health system. The year prior, Ken Kesey’s One Flew Over the Cuckoo’s Nest had brought attention to the crude treatments in mental institutions, and like the novel’s protagonist, the president’s sister Rosemary had received a lobotomy that left her profoundly disabled. Kennedy sought to end the “reliance on the cold mercy of custodial isolation,” he said in a statement to Congress.
Dedication to improving the country’s approach to mental health became a family project. In 1962, Eunice Kennedy Shriver started a sports camp for people with intellectual disabilities, which became the Special Olympics. In the 1970s, Senator Edward Kennedy tried to fix living conditions in mental institutions; in the ’90s, he helped establish the Substance Abuse and Mental Health Services Administration. Recently, his nephew Robert F. Kennedy Jr., the current secretary of Health and Human Services, subsumed that agency into a new one: the Administration for a Healthy America, which includes mental health as one of its focuses.
RFK Jr.’s policy plans have not yet taken form. So far, he has overseen deep cuts to HHS and begun reorganizing the agency internally. He has met once, reportedly, in private with the Make America Healthy Again Commission, created by the president to address chronic health issues; one of its stated goals is to assess the threat of prescription psychiatric drugs. (HHS did not respond to a request for comment.) When speaking publicly, Kennedy has repeatedly returned to the idea that American doctors overprescribe such drugs.
Kennedy is skilled at picking up on frustrations in the zeitgeist. The sentiment that doctors over-rely on psychiatric drugs, while neglecting side effects or difficulty tapering doses, has been receiving more public attention. Consistent and affordable access to therapists, or to economic and housing support, is hard to come by. Yet to the extent that RFK Jr. has revealed his own thinking on how to address those complaints, his suggestions remain isolated from robust debates about mental-health treatment. His clearest proposal, still, is his campaign promise to create wellness farms where Americans would reconnect with the soil and “learn the discipline of hard work.” That idea is little more than a retreat to well-trodden calls to address mental distress through seemingly natural means, and shows scant interest in the nuances of debate around psychiatric medication, or the ways in which separating people from society for such cures has failed.
Kennedy first brought up wellness farms during his presidential run, and when he painted a picture of pastoral meccas for treating addiction, he joined a tradition that dates back more than 200 years. Take the Retreat, founded in England at the end of the 18th century by a Quaker, William Tuke, who along with the French doctor Phillipe Pinel is considered a father of “moral treatment,” an effort to create humane hospitals. Instead of shackles and corporal punishment, the Retreat provided a stately country home, with acres of land to tend cows and grow food. The doctor Benjamin Rush—who signed the Declaration of Independence—was inspired by moral treatment, and wrote in 1812 that men who “assist in cutting wood, making fires, and digging in a garden, and the females who are employed in washing, ironing, and scrubbing floors, often recover,” whereas those who don’t do any manual labor do not.
Tuke and Pinel believed that farming was especially helpful, and many early asylums in the United States employed a “work as therapy” component, says Neil Gong, a sociologist at UC San Diego. At the time, these institutions were cutting-edge, and those running them believed that the “insane” didn’t have to be locked up in chains to improve. “Mental hospitals started out in the 19th century with very utopian expectations around them and their ability to cure,” says Andrew Scull, a sociologist and the author of Desperate Remedies: Psychiatry’s Turbulent Quest to Cure Mental Illness. By the end of the 19th century, every state had at least one government-funded institution.
But when moral treatment was generalized to larger populations, it fell apart. (The Retreat was designed to take on only 30 patients.) Over time, government-run asylums became overwhelmed with cases, and rampant with abuse. At scale, institutions “rapidly declined into warehouses where lots of unpleasant things happen to the patients, and where patients tended to get lost,” Scull told me.
Including farming didn’t protect against such issues, either. The Fort Worth Narcotic Farm, a federally funded project opened in 1938, promised to blend honest farmwork with recovery from drug addiction. Only 25 percent of patients, one study estimates, stuck to their treatment plan, and most people treated at federal narcotic farms, according to a 1957 study, used drugs after they left. The U.S. Narcotics Farm, which opened in 1935, was the temporary home of many famous jazz musicians, including Chet Baker. But once people left the farm, the majority—nearly 90 percent—relapsed. It closed in 1976 after a congressional inquiry led by Senator Ted Kennedy found that doctors were testing experimental drugs on the people living there, and sometimes giving patients drugs such as heroin and cocaine as a reward.
The idea of farm-based detox is appealing enough that today, plenty of private rehabilitation centers incorporate nature and farming; pastoral work as mental-health treatment has become a luxury good, Gong told me, but is often combined with a suite of other services, including psychiatric support. Still, there isn’t an overwhelming body of evidence that care farms have ever been effective at improving outcomes. One review from 2019 found no proof that “care farms improved people’s quality of life” and limited evidence for improved depression and anxiety. “To champion the wellness farm seems out of left field when other models like permanent supportive housing or supportive employment have a huge evidentiary base, including cost-effectiveness,” Ryan K. McBain, a health economist at the RAND Corporation, told me. If Kennedy wanted to, he might tap the Center for Medicare & Medicaid Innovation, which evaluates new programs, to assess how effective a state-run wellness farm could be. This month, however, the CMMI announced that it is cutting funding for several of its programs.
The most revealing aspect of Kennedy’s plan isn’t what people would do on these farms, but what they wouldn’t—take any sort of psychiatric drugs. In describing the farms, Kennedy painted a picture of them as detox centers where people would also taper off medications for depression and ADHD. In the moral-treatment times, drugs such as antidepressants and Ritalin didn’t exist; moral treatment was, nevertheless, seen as alternatives to barbaric interventions such as bloodletting and restraint. For Kennedy, the wellness farm is the same: a substitute for, not a complement to, other treatments.
The role that psychiatric drugs play in Americans’ mental-health treatment is a real and active debate. For many people, psychiatric medications can be a crucial part of their recovery. Yet contemporary psychiatrists have plenty of complaints about insurance companies that reimburse more for medication than for other treatments and a pharmaceutical industry riddled with conflicts of interest. In 2025, people working in this field recognize that the ways in which drugs have claimed to treat mental illness have oversimplified or overemphasized biology. Deliberations on the origin of and rightful reaction to mental distress are core to psychiatry: Michel Foucault thought that psychiatry could be a pernicious force to control society; the psychiatrist Thomas Szasz thought that mental illness was a myth altogether.
However, Kennedy hasn’t engaged with any of these topics substantially. Instead, he has muddied the water with false claims, including that antidepressants are associated with school shootings and are more addictive than heroin. In a podcast last year, he said that wellness farms free of psychiatric drugs would be especially helpful for Black children: “Every Black kid is now just standard put on Adderall, on SSRIs, benzos, which are known to induce violence, and those kids are going to have a chance to go somewhere and get re-parented.”
In this way, Kennedy’s wellness-farms proposal shows how his thinking about public health is defined almost entirely by his naturalness bias—that “natural” treatments are always better, and that manual labor and fresh air, or simply the right diet, could resolve complex and widespread health problems. (“They’re going to grow their own food, organic food, high-quality food, because a lot of the behavioral issues are food-related,” Kennedy said about the farms.) This is consistent with his ideas about vaccination—that natural exposure to disease might be desirable, and that dealing with diseases such as measles with diet and sanitation, as the country did in the first half of the 20th century, is preferable.
But we’ve learned plenty in the past 50, if not 200, years. Facilities that take people out of their community have limited capacity, on their own, to be an effective public-health measure. A more radical idea than wellness farms would be treating people in their community, with a mixture of care options that they can choose from. That idea is also closer to what John F. Kennedy had in mind when he signed the Community Mental Health Act in 1963. He didn’t simply want to close government-run mental centers; he aimed to create 1,500 community mental-health centers. This goal went unrealized. Community mental-health care gives a person access to an interdisciplinary case-management team of social workers, nurses, doctors, and psychologists, and to social services such as housing and employment support. Creating that at scale presents a more obvious and necessary challenge than sending people away to a farm to breathe fresh air and till the land.
Using the platform was dangerous and wrong – but officials appeared to prioritize shielding themselves from litigation
No senior US government official in the now-infamous “Houthi PC Small Group” Signal chat seemed new to that kind of group, nor surprised by the sensitivity of the subject discussed in that insecure forum, not even when the defense secretary, Pete Hegseth, chimed in with details of a coming airstrike. No one objected – not the director of national intelligence, Tulsi Gabbard, who was abroad and using her personal cellphone to discuss pending military operations; not even the presidential envoy Steve Witkoff, who was in Moscow at the time. Yet most of these officials enjoy the luxury of access to secure government communications systems 24/7/365.
Reasonable conclusions may be drawn from these facts. First, Trump’s national security cabinet commonly discusses secret information on insecure personal devices. Second, sophisticated adversaries such as Russia and China intercept such communications, especially those sent or received in their countries. Third, as a result, hostile intelligence services now probably possess blackmail material regarding these officials’ indiscreet past conversations on similar topics. Fourth, as a first-term Trump administration official and ex-CIA officer, I believe the reason these officials risk interacting in this way is to prevent their communications from being preserved as required by the Presidential Records Act, and avoid them being discoverable in litigation, or subject to a subpoena or Freedom of Information Act request. And fifth, no one seems to have feared being investigated by the justice department for what appears to be a violation of the Espionage Act’s Section 793(f), which makes gross negligence in mishandling classified information a felony; the FBI director, Kash Patel, and attorney general, Pam Bondi, quickly confirmed that hunch. Remarkably, the CIA director John Ratcliffe wouldn’t even admit to Congress that he and his colleagues had made a mistake.
Elon Musk said a chart about noncitizens receiving Social Security numbers was “mind-blowing.” But it didn’t show anything nefarious or new. By law, noncitizens who are authorized to work in the U.S. receive Social Security numbers so they can pay taxes.
A group of nonprofits challenging the layoffs of thousands of probationary employees urged the Supreme Court to leave in place an order by a federal judge in San Francisco that would require the federal government to reinstate more than 16,000 employees who were fired by six agencies in February. “It strains credulity that returning employees to work would cause irreparable harm to the Government,” the group said in a 40-page filing, “when these employees had the same workplaces, credentials, benefits, and training just a few weeks ago.”
In the federal government, probationary employees are those who have been newly hired for a position, normally within the past year. Not all probationary employees are new to the federal government or the workforce, however; the term also applies to experienced federal employees who transfer to a new role. In February, the Trump administration fired tens of thousands of probationary employees as part of its broader effort to shrink the size of the federal workforce.
The nonprofits that contend that layoffs could lead to fewer government services, affecting their members, went to federal court on Feb. 19, arguing that the Office of Personnel Management’s actions violated several different provisions of the federal law governing administrative agencies.
The government insisted that OPM had not been responsible for any of the firings. But Senior U.S. District Judge William Alsup concluded, based on a “mountain of evidence,” that “OPM directed other agencies to fire their probationary employees” under false pretenses – with the agencies citing poor performance but with OPM telling the agencies themselves that performance ratings did not matter in determining who should be fired.
At a hearing on March 13, Alsup issued a preliminary injunction that ordered OPM and six agencies – the Departments of Veterans Affairs, Agriculture, Defense, Energy, Interior, and the Treasury – to immediately reinstate the probationary employees who had been fired.
The U.S. Court of Appeals for the 9th Circuit fast-tracked the government’s appeal, setting a briefing schedule that requires the government to file its opening brief on April 10, but declined to pause Alsup’s order while that appeal plays out.
Acting Solicitor General Sarah Harris went to the Supreme Court on March 25, asking the justices to intervene. Alsup’s ruling, she contended, allows “third parties” like the groups in this case to “highjack the employment relationship between the federal government and its workforce.”
In their filing on Thursday, the groups counter that the government is wrong when it contends that the groups lack a legal right to sue, known as standing, to challenge the firings of probationary employees. For example, they note, the termination of probationary employees who worked for the Department of Veterans Affairs “has already had and will imminently continue to have serious negative consequences” for members of the veterans’ non-profit in the case.
Nor is the government correct, the groups continue, when that it contends that “no one can challenge the illegal mass firing of federal employees by OPM, because the only way to challenge termination of federal employees is” for each individual employee to go to the Merit Systems Protection Board.
And Alsup did not go beyond his power, the groups say, when he ordered the government to reinstate fired employees. Instead, he merely “restored the status quo that existed prior to OPM’s illegal conduct, and reinstatement is a routine remedy in the fact of illegal termination.”
A federal district court in Maryland also issued an order that temporarily stopped the firings, and required the reinstatement, of probationary employees at 20 different federal agencies who live and work in the 19 states (along with the District of Columbia) that brought the case.
The U.S. Court of Appeals for the 4th Circuit rejected the government’s request to put that order on hold. The government’s efforts to comply with the district court’s order in this case, the groups suggest, establish that any burden on the government from complying with Alsup’s order to reinstate the fired probationary employees is not insurmountable.
The Supreme Court on Wednesday was divided over whether Planned Parenthood has a legal right under federal civil rights laws to challenge the order by South Carolina’s governor barring abortion clinics, including Planned Parenthood, from participating in Medicaid.
During more than 90 minutes of oral arguments, the justices struggled to determine whether the Medicaid law on which Planned Parenthood relies must use specific words to signal that Congress intended to create a private right to enforce it – and, if so, what those words might be.
For 60 years, the Medicaid program has provided medical care to more than 72 million Americans of limited financial means. Congress enacted the law pursuant to its power under the Constitution’s spending clause, which allows it to attach conditions to the federal funds that it gives to states.
In 2018, South Carolina Governor Henry McMaster ordered the state’s Department of Health and Human Services to prohibit abortion clinics from participating in the Medicaid program. Federal law generally bars the use of Medicaid funds for abortions. Planned Parenthood provides other medical services, such as gynecological and reproductive care but also screenings for cancer, high blood pressure, and high cholesterol. But because money is fungible, McMaster reasoned, any Medicaid funds that go to clinics where abortion is provided would effectively subsidize “abortion and the denial of the right to life.”
Julie Edwards, a Medicaid patient in South Carolina who suffers from diabetes and has used Planned Parenthood for birth control, went to federal court in South Carolina along with Planned Parenthood. They contended that McMaster’s order violated a provision of the Medicaid Act that allows any patient who is eligible for Medicaid to seek health care from any “qualified” provider.
The U.S. Court of Appeals for the 4th Circuit agreed with Planned Parenthood and Edwards that the Medicaid Act creates individual rights that can be enforced under federal civil rights laws, and it barred the state from excluding Planned Parenthood from its Medicaid program.
John Bursch, a lawyer for the conservative advocacy group Alliance Defending Freedom, represented the state. He told the justices that for laws enacted pursuant to Congress’s spending clause power, “clear rights-creating language is critical to creating private rights. Congress did not use” such language in the “any qualified provider” provision, he stressed. Indeed, he noted, Congress “knows how to clearly confer a private right to choose a provider” when it wants to do so, as it did in the Federal Nursing Home Reform Act.
Justice Clarence Thomas asked Bursch whether the word “right” is “absolutely necessary in order to determine whether or not a right has been created” under the “any qualified provider” provision.
Bursch answered that “if Congress wants to be clear, ‘right’ is the best word, but we would take its functional equivalent” – for example, “entitlement” or “privilege.”
Thomas’s question kicked off a debate that continued on and off throughout the morning’s argument: Does a federal law only create a privately enforceable right if it uses specific – or as some justices put it, “magic” – words?
Justice Sonia Sotomayor told Bursch, “You’re not quite calling it a magic word, but you’re coming very close.”
Bursch countered that what states need is a “clear statement” about their obligations under the Medicaid Act.
But Sotomayor was unconvinced. “It seems a little bit odd,” she suggested, “to think that a problem that motivated Congress to pass this provision was that states were limiting the choices people had.” In light of that history, she posited, it “seems hard to understand that states didn’t understand that they had to give individuals the right to choose a provider.”
Justice Amy Coney Barrett echoed Sotomayor’s concern about the purpose of the “any qualified provider” provision. If I want to go see the provider of my choice, she said, but the state has disqualified him from participating in Medicaid, “You’re depriving me of my ability … to see the provider of my choice. And nobody’s disputing that” the physician “can provide the services in a competent way that I want to have.”
Justice Brett Kavanaugh was more supportive of the idea that laws should have to use specific words to create privately enforceable rights. The Supreme Court, he observed, “has failed to give guidance … that lower courts can follow, that states, providers, and beneficiaries can follow.” What words, he asked Bursch, would create such rights, “rather than having something like ‘or its functional equivalent,’ would could” lead to “another decade of litigation”?
Bursch suggested that the words “rights,” “entitlement,” “privileges,” and “immunities” would fit the bill. “If you don’t limit it to those few words,” he told the justices, “then all of a sudden, the floodgates are open.”
Representing the federal government, Kyle Hawkins told the justices that their cases “emphasized that rights-creating statutes are atypical. But” the “any qualified provider” provision, he stressed, “is a run-of-the-mill spending clause statute, and holding otherwise would invite line-drawing problems.”
Sotomayor pressed Hawkins, observing that the federal government for two decades had contended that the “any qualified provider” provision could be privately enforced through federal civil rights laws. Although the government now contends that it had changed its position after the court’s decision in Health and Hospital Corporation of Marion County, Ind. v. Talevski, holding that nursing-home residents could use federal civil rights laws to enforce two provisions of the Federal Nursing Home Reform Act, Sotomayor suggested that in Talevski the court had simply “reiterated” its analysis in an earlier decision. “Did you need a hit over the head,” she asked, “meaning did you need for us to say it a second time before you understood it?”
Kagan contended that imposing a “magic words” requirement would be “kind of changing the rules midstream.” Congress, she emphasized, enacted the Medicaid Act a long time ago. “And if we come in now and say you have to use one of these three words,” she noted, it might be useful for future laws, “but it’s not a fair way to interpret statutes that Congress passed many years ago.”
Unlike Bursch, Hawkins declined to suggest specific words that would create a privately enforceable right. He agreed that words like “right,” “entitlement,” “privilege,” and “immunity” “would count,” but he suggested that “a helpful way to think about it” is that “we’re looking for words that have a real rights-creating pedigree in our nation’s history and legal traditions.”
But that answer did not necessarily please Kavanaugh, who told him that Kagan had “raised good points about how, once you open it up like that, there are going to be line-drawing problems. You’re not going to solve the issue that you came here to solve.”
Nicole Saharsky, who represented Planned Parenthood, told the justices that there is no dispute that South Carolina violated the Medicaid Act when it denied Julie Edwards “her choice of a qualified and willing provider.” “The only question,” she said, “is whether she can do something about it, to sue under” federal civil rights laws.
The “any qualified provider” provision, Saharsky maintained, “uses mandatory, individual-centric, rights-creating language. The only thing it doesn’t do,” she said, “is use the word ‘right.’ And this Court has repeatedly said that magic words aren’t required.”
The justices raised other concerns as well. Barrett questioned whether allowing the 4th Circuit’s ruling to stand would “open the floodgates of people bringing” similar suits, “or is this kind of a pretty unusual circumstance?”
Hawkins answers that it was “hard to say it’s unusual,” adding that the “any qualified provider” provision was “the most litigated provision” in the statute.
Saharsky pushed back against any idea that a ruling in her clients’ favor would lead to more lawsuits, noting that the 6th Circuit had issued a decision similar to the 4th Circuit’s “more than 20 years ago. If the flood of lawsuits was supposed to happen, we would expect to see it.”
Moreover, she added, there is no real benefit to Medicaid patients from bringing lawsuits to challenge the denial of their provider of choice. Money damages are not available, she noted. “These aren’t people getting rich,” she said. “They’re just trying to get healthcare here.”
Kavanaugh voiced what he characterized as a “broader separation-of-powers concern” – the idea that “Congress creates rights of action and remedies, not the Court.” For more than two decades, Kavanaugh told Saharsky, the Supreme Court had “really tightened up” on creating causes of action, “and said essentially that far and no further.”
Saharsky countered that this dispute involves “an express cause of action” under the federal civil rights laws, so there is no need for the court to create one. And she conceded that there “is a high bar to find that Congress put in place an individually-enforceable right. What we’re saying is that this provision meets the bar.”
Justice Samuel Alito was similarly skeptical, describing it as “quite extraordinary” for the court to find that a law enacted pursuant to Congress’s spending clause power creates a privately enforceable right of action. And if a federal civil rights lawsuit can follow “whenever Congress uses the word ‘individual,’” he told Saharsky, “then all sorts of provisions could give rise to” liability. “Congress,” he said a few minutes later, “may well have had in mind” that the state needs to provide Medicaid beneficiaries with the ability to choose their own qualified health-care providers, “but not that this is something that allows an individual to sue in court.”
In his rebuttal, Bursch argued that “the fact that the 12 of us can have such a robust conversation about whether this statute is mandatory or not, whether it’s rights-creating or not, demonstrates that the rights-creating language is ambiguous, not clear and explicit. And if there is any ambiguity in this context,” he concluded, “the state has to win because it’s not being put on notice of when it might be sued.”
